Incidence of metachronous gastric neoplasia after endoscopic submucosal dissection for gastric dysplasia.

20 Background: Endoscopic submucosal dissection (ESD) has been usually performed to treat gastric high-grade dysplasia (HGD) and selected lesions of low-grade dysplasia (LGD). However, HGD was classified into the same category of non-invasive carcinoma which were different from LGD in the Vienna classification of gastrointestinal epithelial neoplasia. We investigated whether the incidence of metachonous gastric neoplasia after ESD for gastric dysplasia is different between patients with LGD and HGD. Methods: Between March 2011 and December 2016, 508 patients underwent ESD for 545 gastric dysplasias or cancers at the Chung-Ang University Hospital. Of them, 198 patients with LGD (LGD group) and 46 with HGD (HGD group) who had been followed up for at least one year were included. The primary outcome was the incidence of gastric neoplasia occurred at 1-year follow-up or later after ESD. The secondary outcome was the composite incidence of metachronous HGD and gastric cancers. Results: During a median follow-up of 2.5 years, overall cumulative incidence of metachronous gastric neoplasm was 33.2 cases/1000 person-years. The metachronous neoplasms developed in 17 patients (8.6%; 11 LGD, 2 HGD and 4 gastric cancers) in the LGD group and in 6 patients (13.0%; 3 LGD, 1 HGD and 3 gastric cancers) in the HGD group. The incidence of metachronous gastric neoplasia in LGD group was not significantly different from that in HGD group (hazard ratio [HR] in the LGD group, 0.56; 95% confidence interval [CI], 0.22-1.43; P = 0.229). The composite incidences of metachronous HGD and gastric cancers were not also different between the two groups (HR for the composite incidences in the LGD group, 0.42; 95% CI, 0.10-1.68; P = 0.218). Conclusions: After ESD for gastric LGD, the incidence of metachronous gastric neoplasia was not different from that after ESD for HGD. Thus, similar surveillance strategies are needed for patients who underwent ESD for LGD and HGD.

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Risk of recurrence when cutting into intramucosal (pT1a) cancer from the cutting-plane side during gastric endoscopic submucosal dissection

Endoscopy ◽

10.1055/a-1173-8575 ◽

2020 ◽

Vol 52 (10) ◽

pp. 833-838

Author(s):

Hiroko Nakahira ◽

Takashi Kanesaka ◽

Noriya Uedo ◽

Masayasu Ohmori ◽

Hiroyoshi Iwagami ◽

...

Keyword(s):

Local Recurrence ◽

Endoscopic Submucosal Dissection ◽

Cutting Plane ◽

Risk Of Recurrence ◽

Gastric Cancers ◽

Submucosal Dissection ◽

Additional Surgery ◽

Risk Factors For Recurrence ◽

Surveillance Endoscopy

Background During endoscopic submucosal dissection (ESD), procedural difficulty and poor visibility of the cutting plane sometimes cause the operator to cut into the lesion from the cutting-plane side, making the vertical margin positive (VM1) or unclear (VMX). In the present study, we evaluated the risk of recurrence of gastric cancer with VM1 /VMX after ESD. Methods In total, 1723 consecutive gastric cancers treated by ESD at Osaka International Cancer Institute from July 2012 to December 2017 were included in this retrospective cohort study. Among them, 231 submucosal or more deeply invasive gastric cancers were excluded because nontechnical factors may contribute to VM1 /VMX in such lesions. To quantify the risk of cutting into cancer from the cutting-plane side during ESD, the proportion of lesions with VM1 /VMX among the pT1a gastric cancers treated by ESD was calculated. The proportion of recurrence among these cases was calculated after exclusion of lesions with positive lymphovascular invasion or a positive horizontal margin in order to eliminate the obvious risk factors for recurrence. Results Among 1492 pT1a gastric cancers treated by ESD, 28 lesions (1.9 %; 95 % confidence interval [CI] 1.3 % – 2.7 %) histologically showed VM1 /VMX. No local recurrence (0.0 %; 95 %CI 0.0 % – 12.2 %) occurred among 23 cases. The median follow-up period was 41 months (range 10 – 84 months). Conclusions No local recurrence was detected in pT1a gastric cancers after VM1 /VMX resection by ESD. Surveillance endoscopy could be adopted for such cases without additional surgery.

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Neutrophil Infiltration and the Distribution of Intestinal Metaplasia Is Associated with Metachronous Gastric Cancer following Endoscopic Submucosal Dissection

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2015/950734 ◽

2015 ◽

Vol 29 (6) ◽

pp. 321-325 ◽

Cited By ~ 9

Author(s):

Takafumi Sugimoto ◽

Yutaka Yamaji ◽

Kosuke Sakitani ◽

Yoshihiro Isomura ◽

Shuntaro Yoshida ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Intestinal Metaplasia ◽

Neutrophil Infiltration ◽

Rank Test ◽

Gastric Cancers ◽

Submucosal Dissection ◽

Metachronous Gastric Cancer

BACKGROUND: Endoscopic submucosal dissection (ESD) of early gastric cancer is a minimally invasive procedure. However, the risk for metachronous cancers after successful cancer treatment remains high and the risk factors for metachronous cancers have not been elucidated.OBJECTIVE: To evaluate the risk factors for metachronous gastric cancers after ESD with a long-term follow-up.METHODS: A total of 155 consecutive patients (119 men, 36 women, mean age 68.9 years) were treated with ESD between September 2000 and September 2009. Biopsy specimens were obtained from the greater curvature of the antrum and middle corpus to evaluate gastric mucosal status, includingHelicobacter pylori, intestinal metaplasia (IM) and neutrophil infiltration (NI) before ESD. Follow-up endoscopy after ESD was scheduled at two and six months, one year and annually thereafter.H pylorieradication was recommended when possible.RESULTS: The median follow-up period was 4.2 years. Metachronous gastric cancers were found in 23 of 155 patients (3.5% per year). No local recurrences were observed. The cumulative incidence of metachronous gastric cancer was significantly high in IM and NI in the corpus (P=0.0093 and P=0.0025, respectively [log-rank test]). The ORs for IM and NI in the corpus were 2.65 and 3.06, respectively, according to the Cox proportional hazards model (P=0.024 and P=0.0091, respectively).CONCLUSIONS: The presence of IM and NI in the corpus was closely related to the development of metachronous gastric cancer after ESD.

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P656 Clinical implications of endoscopic submucosal dissection in management of patients with ulcerative colitis-associated dysplasia

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.784 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S540-S541

Author(s):

T Sakurai ◽

R Nezu ◽

A Okada ◽

Y Komeda ◽

T Nagai ◽

...

Keyword(s):

Ulcerative Colitis ◽

Endoscopic Submucosal Dissection ◽

Tp53 Mutation ◽

Magnifying Endoscopy ◽

Clinical Implications ◽

Low Grade ◽

Submucosal Dissection ◽

Metachronous Colorectal Cancer ◽

Gene Mutation Analysis

Abstract Background Colectomy has been recommended for patients presenting ulcerative colitis (UC)-associated dysplasia because of the risk of metachronous recurrence. However, it has been recently proposed that endoscopic submucosal dissection (ESD) of dysplasia, combined with subsequent surveillance, may contribute to avoiding colectomy. This study assessed clinical implications of ESD in UC-associated dysplasia. Methods We investigated 30 lesions (27 patients) of UC-associated dysplasia/cancer treated with ESD and surgery (15 ESD and 16 surgery) including a patient who underwent surgery following ESD. Among them, paraffin-embedded tissues of 15 lesions (6 cancers, 7 high-grade dysplasia: HGDs, 2 low-grade dysplasia: LGDs) and 11 surrounding mucosae were available and gene mutation analysis was performed. Indications for ESD were determined according to the criteria applied for sporadic colorectal neoplasms that are based on magnifying endoscopy. Results The median follow-up duration was 40 months. Three out of 27 patients (11%) developed metastasis. Although no serious complications, local recurrence, or metastasis occurred in 13 patients undergoing ESD, one out of them (7.7%) had metachronous colorectal cancer 3 years after ESD in the rectum, where TP53 mutation and diffuse p53 staining was found at non-dysplastic mucosae. Based on magnifying endoscopy, we underestimated the invasion depth in two cases: in a case of deeply submucosal invasive mucinous cancer, endoscopic ultrasonography exhibited thickening of the submucosal layer exclusively at the lesion. Conclusion The proposed indication for ESD in UC-associated dysplasia is that a lesion is well-demarcated and surrounding mucosa is not actively inflamed and does not exhibit diffuse p53 staining. ESD would contribute to advances in the management of UC-associated dysplasia.

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Risk of metachronous gastric neoplasm occurrence during intermediate-term follow-up period after endoscopic submucosal dissection for gastric dysplasia

Scientific Reports ◽

10.1038/s41598-020-63722-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Young-Il Kim ◽

Jae Yong Park ◽

Beom Jin Kim ◽

Hye Won Hwang ◽

Soon Auck Hong ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Gastric Neoplasm ◽

Submucosal Dissection ◽

Gastric Dysplasia

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First experience of one and two-step endoscopic submucosal dissection of colorectal neoplasms

Kazan medical journal ◽

10.17816/kmj2020-446 ◽

2020 ◽

Vol 101 (3) ◽

pp. 446-451

Author(s):

I M Sayfutdinov ◽

L E Slavin ◽

R N Khayrullin ◽

M S Mukharyamov ◽

R T Zimagulov ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Colorectal Neoplasms ◽

Intraoperative Complications ◽

Intraepithelial Neoplasia ◽

Intestinal Wall ◽

Colorectal Polyps ◽

Low Grade ◽

En Bloc ◽

Submucosal Dissection

Aim. To analyze the results of one and two-step endoscopic submucosal dissection in the treatment of colorectal neoplasms. Methods. Between 2018 and 2019, 17 patients (6 men and 11 women) aged 33 to 79 years underwent 21 endoscopic submucosal dissections of colorectal neoplasms ranging in size from 1.0 to 6.0 cm. Submucosal fibrosis was identified in 2 (11.8%) patients, epithelial neoplasms in 15 (88.2%) patients including laterally spreading tumors in 9 (60%), and large sessile colorectal polyps in 6 (40%) patients. Histological examination revealed a carcinoid tumor (11.8%), adenoma with low-grade (64.7%) and high-grade (23.5%) intraepithelial neoplasia. 13 patients were subjected to the one-step operation, and 4 patients required the two-step operation with a 1-day interval. Follow-up examinations after the operation were performed, on average, between 2 and 6 months. Results. En bloc endoscopic submucosal dissection was performed in 11 (64.7%) patients, 4 of them in combination with mucosal resection. Endoscopic piecemeal resection of the neoplasia was performed in 6 (35.3%) patients. The average operative time was 15573 minutes (range 40320 min). Intraoperative complications, which were eliminated endoscopically, occurred during 8 (38.1%) of 21 operations: intensive bleeding in 6 (75%) patients, diastasis of muscle fibers in 1 (12.5%) patient, perforation of the intestinal wall in 1 (12.5%) patient. At the follow-up at 6 months, all patients formed the scar at the surgical area, while 3 patients required endoscopic removal of residual adenoma 2 months after the operation. Conclusion. Endoscopic submucosal dissection is an effective method for removing colorectal neoplasms, while two-step dissection is a promising approach to the development of the technique.Keywords: one and two-step dissection, endoscopic submucosal dissection (ESD), colorectal neoplasms.

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Surveillance strategy based on the incidence and patterns of recurrence after curative endoscopic submucosal dissection for early gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.87 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 87-87

Author(s):

Jae J. Kim

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Cancer Progression ◽

Surveillance Period ◽

Surveillance Strategy ◽

Gastric Cancers ◽

Submucosal Dissection ◽

Cumulative Incidence Curve

87 Background: To suggest an appropriate surveillance strategy after curative endoscopic submucosal dissection (ESD) for early gastric cancers, based on incidence and patterns of local, metachronous, and extragastric recurrence. Methods: Between 2003 and 2011, 1497 consecutive patients with 1539 differentiated-type early gastric cancers meeting absolute or expanded indication criteria underwent curative ESD. They were followed up with esophagogastroduodenoscopy (EGD) and abdominal computed tomography (CT) under a standardized surveillance protocol. Long-term outcomes were analyzed for 1306 patients with at least 1 year’s follow-up. Results: Incidences of residual and synchronous lesions detected within 1 year were 0.13 % and 0.87 %, respectively. During median 47 months of follow-up, there was 1 local recurrence (0.08 %; early gastric cancer) and 47 cases of metachronous recurrence (3.6 %; 44 early gastric cancers, 3 pT2 advanced gastric cancers); all were curatively treated. During a 5-year surveillance, the cumulative incidence curve of metachronous recurrence increased linearly. Median time from ESD to metachronous recurrence was 30 months. There were 2 extragastric recurrences (0.15 %) in lymph nodes, at 5 and 4 years, respectively, after curative ESD for absolute and expanded indications. The patient with the expanded indications underwent a palliative operation and died of gastric cancer progression. Conclusions: There was a constant incidence rate of metachronous recurrence during a 5-year surveillance period and there was extragastric recurrence at least 4 years after ESD of early gastric cancer even for absolute indications. Therefore, annual or biannual surveillance EGD and abdominal CT might be necessary for at least 5 years after curative ESD for early gastric cancers, with absolute as well as expanded indications.

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Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions: An Italian, Multicenter Study

Journal of Clinical Medicine ◽

10.3390/jcm9030737 ◽

2020 ◽

Vol 9 (3) ◽

pp. 737

Author(s):

Raffaele Manta ◽

Giuseppe Galloro ◽

Francesco Pugliese ◽

Stefano Angeletti ◽

Angelo Caruso ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

En Bloc Resection ◽

Bloc Resection ◽

R0 Resection ◽

Gastric Lesions ◽

En Bloc ◽

Submucosal Dissection ◽

Neoplastic Lesions ◽

One Year

Endoscopic submucosal dissection (ESD) allows removing neoplastic lesions on gastric mucosa, including early gastric cancer (EGC) and dysplasia. Data on ESD from Western countries are still scanty. We report results of ESD procedures performed in Italy. Data of consecutive patients who underwent ESD for gastric neoplastic removal were analyzed. The en bloc resection rate and the R0 resection rates for all neoplastic lesions were calculated, as well as the curative rate (i.e., no need for surgical treatment) for EGC. The incidence of complications, the one-month mortality, and the recurrence rate at one-year follow-up were computed. A total of 296 patients with 299 gastric lesions (80 EGC) were treated. The en bloc resection was successful for 292 (97.6%) and the R0 was achieved in 266 (89%) out of all lesions. In the EGC group, the ESD was eventually curative in 72.5% (58/80) following procedure. A complication occurred in 30 (10.1%) patients. Endoscopic treatment was successful in all 3 perforations, whereas it failed in 2 out of 27 bleeding patients who were treated with radiological embolization (1 case) or surgery (1 case). No procedure-related deaths at one-month follow-up were observed. Lesion recurrence occurred in 16 (6.2%) patients (6 EGC and 10 dysplasia). In conclusion, the rate of both en bloc and R0 gastric lesions removal was very high in Italy. However, the curative rate for EGC needs to be improved. Complications were acceptably low and amenable at endoscopy.

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