Atypical Scar Patterns after Gastric Endoscopic Submucosal Dissection

Background/Aims: Endoscopic submucosal dissection (ESD) for gastric neoplasms is a widely performed procedure. Local recurrence is rare, but various post-ESD scars are encountered during follow-up endoscopy. Therefore, we investigated atypical scar patterns and evaluated the associated factors.Materials and Methods: Clinicopathologic and endoscopic reviews of gastric neoplasms treated with ESD from January 2009 to December 2015 were conducted. Atypical scar patterns were classified as irregular erythema, nodularity, or mucosal defect.Results: A total of 264 patients with 274 gastric neoplasms, including 201 adenomas and 73 early gastric cancers, were enrolled. The key endoscopic findings at the resection scar were defined on the basis of gross morphology as follows: irregular erythema, mucosal defect (erosion or ulcer), and nodularity. An irregular erythema scar pattern was associated with male sex, a nodularity scar pattern with smoking, and a mucosal defect scar pattern with infra-angle location (angle and antrum) and cancer. An irregular erythema with nodularity scar pattern was also associated with male sex. An irregular erythema with nodularity and mucosal defect scar pattern was associated with liver disease and chronic kidney disease.Conclusions: The atypical scar patterns after gastric ESD are associated with various clinicopathologic factors.

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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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Sa1508 Long-Term Follow-up of Extremely Elderly Patients With Early Gastric Neoplasms Treated by Endoscopic Submucosal Dissection

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.05.127 ◽

2014 ◽

Vol 79 (5) ◽

pp. AB239

Author(s):

Tatsuya Toyokawa ◽

Tomoki Inaba ◽

Koichi Izumikawa ◽

Isao Fujita ◽

Shigenao Ishikawa ◽

...

Keyword(s):

Elderly Patients ◽

Endoscopic Submucosal Dissection ◽

Gastric Neoplasms ◽

Submucosal Dissection ◽

Long Term Follow Up

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Comparison of Autofluorescence Imaging Endoscopic Findings with Pathologic Findings after Endoscopic Submucosal Dissection of Gastric Neoplasms

Gut and Liver ◽

10.5009/gnl.2008.2.3.186 ◽

2008 ◽

Vol 2 (3) ◽

pp. 186-192 ◽

Cited By ~ 4

Author(s):

Wan Jung Kim ◽

Joo Young Cho ◽

Soung Won Jeong ◽

Kyoung Min Kim ◽

Ik Sung Choi ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Gastric Neoplasms ◽

Autofluorescence Imaging ◽

Endoscopic Findings ◽

Submucosal Dissection ◽

Pathologic Findings

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Risk of perforation in balloon dilation associated with steroid injection for preventing esophageal stricture after endoscopic submucosal dissection

Endoscopy International Open ◽

10.1055/s-0043-110077 ◽

2017 ◽

Vol 05 (07) ◽

pp. E573-E579 ◽

Cited By ~ 9

Author(s):

Yoshiki Tsujii ◽

Yoshito Hayashi ◽

Naoki Kawai ◽

Takuya Yamada ◽

Katsumi Yamamoto ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Steroid Injection ◽

Narrow Band Imaging ◽

Healing Process ◽

Balloon Dilation ◽

Submucosal Dissection ◽

Mucosal Defect ◽

Esophageal Strictures ◽

Local Steroid Injection

Abstract Background and study aims Endoscopic local steroid injection (LSI) has been used to prevent esophageal strictures after endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms (SENs). This study aimed to evaluate the safety and efficacy of LSI therapy. Patients and methods From May 2007 to September 2014, at four institutions, 40 consecutive patients with SENs were treated with ESD that left a mucosal defect of more than three-quarters of the esophageal circumference. Two patients who underwent esophagectomy after ESD were excluded, and 38 patients were analyzed. The incidence of post-ESD strictures and adverse events associated with LSI were retrospectively investigated. Results Prophylactic LSI was administered in 28 patients (LSI group), and not administered in 10 patients (Non-prevention group). Post-ESD stricture rates were significantly lower in the LSI group (43 %) than in the Non-prevention group (90 %) (P = 0.012). Endoscopic balloon dilation (EBD) was conducted in 11 patients (39 %) in the LSI group and in 7 (70 %) in the Non-prevention group. In the LSI group, perforation caused by EBD occurred in five patients, while in the Non-prevention group, it occurred in only one patient who had received subsequent LSI before the perforation. Four patients with perforation successfully recovered after conservative therapy, but the other two patients required surgical treatment. A review of follow-up examinations with endoscopic ultrasonography and narrow-band imaging showed impaired ulcer-healing process after LSI. Conclusion LSI is useful for preventing post-ESD strictures, but it appears to increase the risk of perforation in cases of EBD.

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