Endoscopic submucosal dissection for early gastric cancer in anastomosis site after distal gastrectomy

Abstract

Background Detection of early gastric cancer (EGC) in the remnant stomach is increasing because of follow-up endoscopic surveillance programs. Endoscopic treatment appears to be desirable for EGC in the remnant stomach because it is less invasive than surgical resection. Methods In this retrospective study, to evaluate the feasibility of endoscopic submucosal dissection (ESD) for EGC in an anastomotic site, treatment results of ESD for EGC in an anastomotic site and in remnant stomach not involving an anastomotic site were compared. In total, 11 EGC lesions of anastomotic sites in 11 patients and 22 EGC lesions of remnant stomach not involving an anastomotic site in 21 patients were treated by ESD. Results All lesions were successfully treated by en bloc resection. There were three patients with perforations in the anastomotic site group. Although resected specimen size and tumor size were larger in the anastomotic site group than in the non-anastomotic site group (P \ 0.01), the procedure duration was far longer in the anastomotic site group than in the non-anastomotic site group (P \ 0.01). The speed of the procedure was faster in the nonanastomotic site group than in the anastomotic site group (P \ 0.05). Conclusions Although ESD for EGC in an anastomotic site is a time-consuming procedure and requires advanced techniques compared with ESD for EGC not involving an anastomotic site, a high en bloc resection rate was achieved. ESD by endoscopists with sufficient experience appears to be a feasible treatment for EGC in an anastomotic site.

Safety and efficacy of endoscopic submucosal dissection for metachronous early cancer or precancerous lesions emerging at the anastomotic site after curative surgical resection of colorectal cancer

“…Then, the submucosal tissue can be stripped around the ANs step by step, and finally, the ANs can be gently and successfully pulled out (see in Figure 1C). This method can reduce the incidence of perforation and may explain why our perforation rate is much lower than that of ESD for early gastric remnant cancer emerging at the AS (17,27).…”

Propensity score-matching analysis to compare clinical outcomes of endoscopic submucosal dissection for early gastric cancer in the postoperative and non-operative stomachs

“…Lesions on the suture line or anastomotic site involve the submucosal fibrosis [ 9 , 13 , 15 ]; therefore, performing ESD for these lesions was difficult to complete. In the present study, 17 lesions had developed on the suture line of the postoperative stomach, whereas 2 lesions on the anastomotic site.…”

“…However, ESD-P for EGC is known as a technically difficult procedure because of the presence of submucosal fibrosis and staples around the suture line or anastomotic site [ 9 – 13 ]. Some reports have shown high resection rates but with a higher risk of complications with ESD-P than with ESD-N [ 14 , 15 ].…”

Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy

“…However, if the lesion involves an anastomotic site, the technical difficulty is expected to increase. We previously reported that ESD for RGCs in an anastomotic site is more time-consuming and complex than ESD for RGCs at a non-anastomotic site [ 12 ].…”

“…We previously reported that ESD for RGCs in an anastomotic site is more time-consuming and complex than ESD for RGCs at a non-anastomotic site. 12 The three main reconstruction methods used for distal gastrectomy were Billroth I (B-I), Billroth II (B-II), and Rouxen-Y (RY). These methods have been reported to cause different degrees of duodenogastric reflux, [13][14][15][16] with B-II causing more reflux than the other reconstruction methods.…”