Sa1638 Risk Factors for Local Recurrence After En Bloc Resection of Endoscopic Submucosal Dissection for the Early Gastric Cancer Treatment

Abstract

Clinical data concerning patients in whom a PEJ was scheduled between 1/2006 and 1/2010 were retrospectively collected and analyzed. Results: Twenty-two patients were included. In 4 patients, the procedure was unsuccessful, due to lack of translumination; therefore the success rate was 81%. In 3 of these patients, a percutaneous endoscopic gastrostomy with a jejunal extension was placed and one patient underwent surgery. The remaining 18 patients (10 men, 8 women) who underwent successful PEJ placement had a median age of 57 years (22-79) and a body mass index of 18,5 (13-33). Regarding underlying disease, 5 patients (27.8%) had previous lung transplantation and 7 (38.9%) had gastrectomy. Indications for jejunal access were as follows: gastroparesis (n 5, 27.8%), gastrectomy (n 7, 38.9%) and severe reflux (n 6, 33.3%). Eight patients had previous nasogastric (n 2) or nasojejunal (n 6) tube. An enteroscope was used in 11 patients, whereas a gastroscope was used in 6 and a pediatric colonoscope in 1 patient. Eighteen french tubes with an internal bumper were used in all patients. No patient presented with short-term complications. Six patients had long-term complications (tube migration and local infection). Seven patients required a second procedure during follow-up. Enteral feeding was well tolerated in 13 patients (72.2%) and weight gain was observed in 6 (33.3%). Total median length of jejunal feeding was 6 months (1-36). Conclusions: PEJ is a useful endoscopic alternative for providing enteral nutrition when gastrostomy is not possible. Frequent indications in our series include previous gastrectomy and gastroparesis following lung transplantation. Sa1638 Risk Factors for Local Recurrence After En Bloc Resection of Endoscopic Submucosal Dissection for the Early Gastric Cancer Treatment Eunsoo Kim, Kwangbum Cho, Kyung Sik Park Internal medicine, Keimyung University School of Medicine, Daegu, Republic of Korea Backgrounds/Aim: Endoscopic submucosal dissection (ESD) has been accepted as an alternative method to surgery for the treatment of early gastric cancer (EGC). Piecemeal resection has been reported to be associated with the local recurrence after ESD. However, there is no study evaluating local recurrence after en bloc resection of ESD. The aim of this study was to assess risk factors for local recurrence after en bloc resection of ESD for the treatment of EGC. Methods: From April 2003 to May 2010, patients with EGC treated by ESD and followed up for at least 6 months were eligible for this study and their medical records were evaluated retrospectively. We excluded the lesions removed by the way of a piecemeal resection and involved in the deep margin pathologically. The lesions with lateral safety margin less than 1 mm was considered as the inadequate group. Results: Among 1,215 gastric epithelial lesions in 1,121 patients, 415 EGC lesions in 401 patients were included (median age 66 (32-87), male 291, median follow-up month 14.8). The overall recurrence rate was 8.7% (36/415) and EGC with ill defined margin was identified as a significant independent risk factor for local recurrence in the multivariate analysis (OR 2.369, 95% CI 1.101-5.098, p 0.027). The cumulative recurrence was more observed in the inadequate group (lateral safety margin 1 mm) through Kaplan-Meier analysis (p 0.019). Multivariate predictive factor for inadequate lateral safety margin was the tumor location (upper third vs. lower third, p 0.001). Conclusion: Aside from achievement of en bloc resection during ESD, efforts should be made to identify the clear lateral margin of tumor for avoiding local recurrence. Endoscopists should pay attention to obtain an adequate tumor safety margin especially in upper-located gastric tumor lesions.