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Surgical Endoscopy

, Volume 33, Issue 12, pp 3976–3983 | Cite as

Endoscopic submucosal dissection for gastric indefinite for neoplasia: which lesions should be resected?

  • Hyeong Seok Nam
  • Cheol Woong ChoiEmail author
  • Su Jin Kim
  • Dae Hwan Kang
  • Hyung Wook Kim
  • Su Bum Park
  • Dae Gon Ryu
Article
  • 67 Downloads

Abstract

Background and study aims

The management plan for gastric indefinite for neoplasia is undetermined, and endoscopic forceps biopsy might be inconclusive in ascertaining whether a resection is required. This study aimed to evaluate the clinical outcomes of endoscopic submucosal dissection (ESD) for gastric indefinite for neoplasia and to identify the factors highly predictive of true neoplasia.

Patients and methods

This retrospective study was conducted in a single, tertiary, referral hospital between November 2008 and December 2015. A total of 109 gastric indefinite for neoplasia lesions from endoscopic forceps biopsy that were resected by ESD were included in the study. The clinical outcomes and endoscopic factors for prediction of true neoplasia were analyzed.

Results

A total of 99 patients (90.8%) were diagnosed with definite neoplasia after ESD and were classified as category 3 (n = 42), category 4 (n = 50), and category 5 (n = 7) according to the revised Vienna classification. The mean age of the patients was 65.8 ± 9.8 years. The mean lesion size was 10.7 ± 6.1 mm. The patient population predominantly consisted of male patients (70.6%). The en bloc and complete endoscopic resection rates were 98.2% and 94.5%, respectively. Factors associated with true neoplastic lesions were male sex (odds ratio [OR] 8.596, p = 0.008) and lesion size ≥ 5 mm (OR 11.355, p = 0.003). Factors associated with category 4–5 were male sex (OR 3.165, p = 0.021) and erosive change (OR 2.841, p = 0.031).

Conclusions

Endoscopic resection for indefinite for neoplasia with larger lesions size and erosive changes, especially in males, should be considered when possible.

Keywords

Neoplasia Biopsy Endoscopic submucosal dissection Gastric cancer 

Notes

Acknowledgements

Hyeong Seok Nam and Cheol Woong Choi share first authorship.

Compliance with ethical standards

Disclosures

HS Nam, CW Choi, SJ Kim, DH Kang, HW Kim, SB Park, and DG Ryu have no conflicts of interest or financial ties to disclose.

Ethical approval

Written informed consent was obtained from all patients prior to the procedure. The study was approved by the ethics committee of the Institutional Review Board.

References

  1. 1.
    Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, Dixon MF, Fenoglio-Preiser CM, Flejou JF, Geboes K, Hattori T, Hirota T, Itabashi M, Iwafuchi M, Iwashita A, Kim YI, Kirchner T, Klimpfinger M, Koike M, Lauwers GY, Lewin KJ, Oberhuber G, Offner F, Price AB, Rubio CA, Shimizu M, Shimoda T, Sipponen P, Solcia E, Stolte M, Watanabe H, Yamabe H (2000) The Vienna classification of gastrointestinal epithelial neoplasia. Gut 47:251–255CrossRefGoogle Scholar
  2. 2.
    Dixon MF (2002) Gastrointestinal epithelial neoplasia: Vienna revisited. Gut 51:130–131CrossRefGoogle Scholar
  3. 3.
    Yu CH, Jeon SW, Kim SK, Lee HS, Heo J, Kwon YH, Kim GY, Kim SZ, Bae HI (2014) Endoscopic resection as a first therapy for gastric epithelial atypia: is it reasonable? Dig Dis Sci 59:3012–3020CrossRefGoogle Scholar
  4. 4.
    Ryu DG, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ, Nam HS (2017) Clinical outcomes of endoscopic submucosa dissection for high-grade dysplasia from endoscopic forceps biopsy. Gastric Cancer 20:671–678CrossRefGoogle Scholar
  5. 5.
    Choi CW, Kim HW, Shin DH, Kang DH, Hong YM, Park JH, Park SB, Cho M, Lee JH (2014) The risk factors for discrepancy after endoscopic submucosal dissection of gastric category 3 lesion (low grade dysplasia). Dig Dis Sci 59:421–427CrossRefGoogle Scholar
  6. 6.
    Kim JH, Nam HS, Choi CW, Kang DH, Kim HW, Park SB, Kim SJ, Hwang SH, Lee SH (2017) Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD. Surg Endosc 31:1617–1626CrossRefGoogle Scholar
  7. 7.
    Choi CW, Kang DH, Kim HW, Park SB, Kim S, Cho M (2012) Endoscopic submucosal dissection as a treatment for gastric adenomatous polyps: predictive factors for early gastric cancer. Scand J Gastroenterol 47:1218–1225CrossRefGoogle Scholar
  8. 8.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRefGoogle Scholar
  9. 9.
    Mihara M, Haruma K, Kamada T, Komoto K, Yoshihara M, Sumii K, Kajiyama G (1999) The role of endoscopic findings for the diagnosis of Helicobacter pylori infection: evaluation in a country with high prevalence of atrophic gastritis. Helicobacter 4:40–48CrossRefGoogle Scholar
  10. 10.
    Goo JJ, Choi CW, Kang DH, Kim HW, Park SB, Cho M, Hwang SH, Lee SH (2015) Risk factors associated with diagnostic discrepancy of gastric indefinite neoplasia: Who need en bloc resection? Surg Endosc 29:3761–3767CrossRefGoogle Scholar
  11. 11.
    Kim H, Kim JH, Lee YC, Kim H, Youn YH, Park H, Choi SH, Noh SH, Gotoda T (2015) Growth patterns of signet ring cell carcinoma of the stomach for endoscopic resection. Gut Liver 9:720–726CrossRefGoogle Scholar
  12. 12.
    Jeon HK, Ryu HY, Cho MY, Kim HS, Kim JW, Park HJ, Kim MY, Baik SK, Kwon SO, Park SY, Won SH (2014) A randomized trial to determine the diagnostic accuracy of conventional vs. jumbo forceps biopsy of gastric epithelial neoplasias before endoscopic submucosal dissection; open-label study. Gastric Cancer 17:661–668CrossRefGoogle Scholar
  13. 13.
    Graham DY, Schwartz JT, Cain GD, Gyorkey F (1982) Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology 82:228–231CrossRefGoogle Scholar
  14. 14.
    Shimizu S, Tada M, Kawai K (1995) Early gastric cancer: its surveillance and natural course. Endoscopy 27:27–31CrossRefGoogle Scholar
  15. 15.
    Iishi H, Tatsuta M, Okuda S (1985) Endoscopic diagnosis of minute gastric cancer of less than 5 mm in diameter. Cancer 56:655–659CrossRefGoogle Scholar
  16. 16.
    Committee ASoP, Evans JA, Chandrasekhara V, Chathadi KV, Decker GA, Early DS, Fisher DA, Foley K, Hwang JH, Jue TL, Lightdale JR, Pasha SF, Sharaf R, Shergill AK, Cash BD, DeWitt JM (2015) The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc 82:1–8CrossRefGoogle Scholar
  17. 17.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917CrossRefGoogle Scholar
  18. 18.
    Jemal A, Center MM, DeSantis C, Ward EM (2010) Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomark Prev 19:1893–1907CrossRefGoogle Scholar
  19. 19.
    Cho SJ, Choi IJ, Kim CG, Lee JY, Kook MC, Park S, Ryu KW, Lee JH, Kim YW (2011) Risk of high-grade dysplasia or carcinoma in gastric biopsy-proven low-grade dysplasia: an analysis using the Vienna classification. Endoscopy 43:465–471CrossRefGoogle Scholar
  20. 20.
    Park DI, Rhee PL, Kim JE, Hyun JG, Kim YH, Son HJ, Kim JJ, Paik SW, Rhee JC, Choi KW, Oh YL (2001) Risk factors suggesting malignant transformation of gastric adenoma: univariate and multivariate analysis. Endoscopy 33:501–506CrossRefGoogle Scholar
  21. 21.
    Goldstein NS, Lewin KJ (1997) Gastric epithelial dysplasia and adenoma: historical review and histological criteria for grading. Hum Pathol 28:127–133CrossRefGoogle Scholar
  22. 22.
    Suzuki S, Gotoda T, Suzuki H, Kono S, Iwatsuka K, Kusano C, Oda I, Sekine S, Moriyasu F (2015) Morphologic and histologic changes in gastric adenomas after Helicobacter pylori eradication: a long-term prospective analysis. Helicobacter 20:431–437CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanSouth Korea

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