Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

Abstract

Background/AimsEndoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD.MethodsIn total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study.ResultsIn total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%.ConclusionsWe recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.

Clinical outcomes of no residual disease in the specimen after endoscopic resection for gastric neoplasms

“…In a previous study of the long-term clinical outcome of ER for gastric tumor, the overall incidence of local recurrence was reported to be 1.8 % in the standard indication group and 7.0 % in the expanded indication group during an average of 24 months of follow-up [22]. Furthermore, synchronous gastric tumors had an overall incidence of 2.0-12.9 %, and metachronous gastric tumors had a 2.5-5.9 % incidence rate [22,23]. These findings were comparable to the results of our study.…”

Gastric epithelial dysplasia: characteristics and long-term follow-up results after endoscopic resection according to morphological categorization

“…Biopsy was performed at sites suspicious of harboring synchronous or metachronous lesions. A synchronous lesion, including GED and EGC, was defined as either a concomitant lesion at the time of ESD/EMR, or a lesion detected within a 12-month period after ESD or EMR [ 26 , 27 ]. For patients with initial synchronous lesions, the most dysplastic lesion was considered the main lesion.…”

Disección submucosa endoscópica en cáncer gástrico incipiente: experiencia inicial en el Hospital Clínico de la Pontificia Universidad Católica de Chile

“…Por otra parte, es importante destacar que esta lesión correspondía a un tumor tipo IIb. Este tipo de lesiones son ciertamente las de más difícil diagnóstico, pudiendo pasar desapercibidas incluso si la endoscopia es realizada en un centro de alta experiencia 34,35 . Más aún, este riesgo no es diferente al de los pacientes sometidos a gastrectomía sub-total, en los que también podrían pasar desapercibidas este tipo de lesiones en el estómago proximal no resecado.…”