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


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.


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).


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


Neoplasia Biopsy Endoscopic submucosal dissection Gastric cancer 



Hyeong Seok Nam and Cheol Woong Choi share first authorship.

Compliance with ethical standards


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.


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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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