S3595 "Cutting Edge Honjo Masamune Saving Lives" ESD Preferred and Popular for Early Gastric Cancer

Abstract

INTRODUCTION: Gastric cancer (GC) is the second leading cause of cancer-related mortality worldwide and complete resection is the only curative treatment. Historically, total or subtotal gastrectomy was the only curative option. However, with the advances in therapeutic endoscopy, endoscopic submucosal dissection (ESD) has emerged as a minimally invasive treatment option for precancerous lesions and early stage gastric cancer. Here we present a case of large gastric mass that was able to be fully resected using ESD, which was found to be rare GC. CASE DESCRIPTION/METHODS: A 50-year-old female with multiple comorbidities who presented to our Gastrointestinal (GI) clinic for further evaluation of iron deficiency anemia. Her initial endoscopic gastroduodenoscopy (EGD) revealed a 5–6 cm large gastric mass in the greater curvature of the stomach. The mass was hyperechoic, heterogeneous, and extended to the deep mucosal layer on endoscopic ultrasound (EUS). No adjacent lymphadenopathy was noted. Endoscopic biopsies of the mass revealed atypical glandular proliferation with extensive acute inflammation. Resection of the lesion by ESD was planned. After the lesion and its borders were carefully evaluated, the entire circumference of the lesion was marked with the Dual Knife (Olympus, Tokyo, Japan). A submucosal cushion was created using ORISE gel (Boston Scientific) expanding the submucosa and lifting the lesion away from the muscularis propria layer. The Dual Knife was then used to perform incision at the oral aspect of the lesion. Following this, the submucosa was partially dissected using swift coagulation. The submucosa was then further injected with ORISE gel to expand the submucosal space. Further dissection was performed until the lesion was completely separated from the surrounding gastric mucosa. The lesion was removed en bloc from the patient via Roth net. The resected mass measured 5 × 8 cm. Final histopathology revealed Epstein-Barr virus (EBV)-associated gastric adenocarcinoma with lymphoid stroma with negative margins. Metastatic workup was negative, and the tumor was staged as stage 1. No complications were reported. The patient was referred to the Medical and Surgical Oncology clinic and underwent subtotal gastrectomy and lymphadenectomy despite negative margins and against GI recommendation. Notably, all of the surgically resected tissue was negative for malignancy. DISCUSSION: ESD is an effective minimally invasive treatment for premalignant and early stage gastric cancer.