Clinical Endoscopy

Reviews

Surveillance for metachronous cancers after endoscopic resection of esophageal squamous cell carcinoma: Ryu Ishihara; Received October 10, 2023 Accepted December 17, 2023 Published online May 10, 2024; DOI: https://doi.org/10.5946/ce.2023.263 [Epub ahead of print]

Abstract PDF PubReader ePub: The literature pertaining to surveillance following treatment for esophageal squamous cell carcinoma (SCC) was reviewed and summarized, encompassing the current status and future perspectives. Analysis of the standardized mortality and incidence ratios for these cancers indicates an elevated risk of cancer in the oral cavity, pharynx, larynx, and lungs among patients with esophageal SCC compared to the general population. To enhance the efficacy of surveillance for these metachronous cancers, risk stratification is needed. Various factors, including multiple Lugol-voiding lesions, multiple foci of dilated vascular areas, young age, and high mean corpuscular volume, have been identified as predictors of metachronous SCCs. Current practice involves stratifying the risk of metachronous esophageal and head/neck SCCs based on the presence of multiple Lugol-voiding lesions. Endoscopic surveillance, scheduled 6–12 months post-endoscopic resection, has demonstrated effectiveness, with over 90% of metachronous esophageal SCCs treatable through minimally invasive modalities. Narrow-band imaging emerges as the preferred surveillance method for esophageal and head/neck SCC based on comparative studies of various imaging techniques. Innovative approaches, such as artificial intelligence-assisted detection systems and radiofrequency ablation of high-risk background mucosa, may improve outcomes in patients following endoscopic resection.

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Complications of endoscopic resection in the upper gastrointestinal tract: Takeshi Uozumi, Seiichiro Abe, Mai Ego Makiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Yutaka Saito; Clin Endosc 2023;56(4):409-422. Published online June 21, 2023; DOI: https://doi.org/10.5946/ce.2023.024

Abstract PDF PubReader ePub

Endoscopic resection (ER) is widely utilized as a minimally invasive treatment for upper gastrointestinal tumors; however, complications could occur during and after the procedure. Post-ER mucosal defect leads to delayed perforation and bleeding; therefore, endoscopic closure methods (endoscopic hand-suturing, the endoloop and endoclip closure method, and over-the-scope clip method) and tissue shielding methods (polyglycolic acid sheets and fibrin glue) are developed to prevent these complications. During duodenal ER, complete closure of the mucosal defect significantly reduces delayed bleeding and should be performed. An extensive mucosal defect that comprises three-quarters of the circumference in the esophagus, gastric antrum, or cardia is a significant risk factor for post-ER stricture. Steroid therapy is considered the first-line option for the prevention of esophageal stricture, but its efficacy for gastric stricture remains unclear. Methods for the prevention and management of ER-related complications in the esophagus, stomach, and duodenum differ according to the organ; therefore, endoscopists should be familiar with ways of preventing and managing organ-specific complications.

Citations

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International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef
Risk factors for intraoperative and delayed perforation related with gastric endoscopic submucosal dissection
Takuya Mimura, Yoshinobu Yamamoto, Haruhisa Suzuki, Kohei Takizawa, Toshiaki Hirasawa, Yoji Takeuchi, Kenji Ishido, Shu Hoteya, Tomonori Yano, Shinji Tanaka, Norihiko Kudara, Masahiro Nakagawa, Yumi Mashimo, Masahiro Ishigooka, Kazutoshi Fukase, Taichi Sh
Journal of Gastroenterology and Hepatology.2024;[Epub] CrossRef
Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
Gwang Ha Kim
World Journal of Gastroenterology.2023; 29(43): 5800. CrossRef

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Original Articles

Accuracy of administrative claim data for gastric adenoma after endoscopic resection: Ga-Yeong Shin, Hyun Ho Choi, Jae Myung Park, Sang Yoon Kim, Jun Young Park, Donghoon Kang, Yu Kyung Cho, Sung Soo Kim, Myung-Gyu Choi; Clin Endosc 2023;56(3):325-332. Published online March 21, 2023; DOI: https://doi.org/10.5946/ce.2022.147

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Administrative databases provide valuable information for large-cohort studies. This study aimed to evaluate the diagnostic accuracy of an administrative database for resected gastric adenomas.
Methods
Data of patients who underwent endoscopic resection for benign gastric lesions were collected from three hospitals. Gastric adenoma cases were identified in the hospital database using International Classification of Diseases (ICD) 10-codes. The non-adenoma group included patients without gastric adenoma codes. The diagnostic accuracy for gastric adenoma was analyzed based on the pathological reports of the resected specimen.
Results
Among 5,095 endoscopic resections with codes for benign gastric lesions, 3,909 patients were included in the analysis. Among them, 2,831 and 1,078 patients were allocated to the adenoma and non-adenoma groups, respectively. Regarding the overall diagnosis of gastric adenoma with ICD-10 codes, the sensitivity, specificity, positive predictive value, and negative predictive value were 98.7%, 88.5%, 95.2%, and 96.8%, respectively. There were no significant differences in these parameters between the tertiary and secondary centers.
Conclusions
Administrative codes of gastric adenoma, according to ICD-10 codes, showed good accuracy and can serve as a useful tool to study prognosis of these patients in real-world data studies in the future.

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Gastric Cancer Incidence and Mortality After Endoscopic Resection of Gastric Adenoma: A Nationwide Cohort Study
Jae Myung Park, Songhee Cho, Ga-Yeong Shin, Jayoun Lee, Minjee Kim, Hyeon Woo Yim
American Journal of Gastroenterology.2023; 118(12): 2166. CrossRef

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Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection: Wang Fangjun, Leng Xia, Gao Yi, Shen Xiuyun, Wang Wenping, Liu Huamin, Liu Pengfei; Clin Endosc 2022;55(4):525-531. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2021.241

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Endoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection.
Methods
From July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups.
Results
The time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p>0.05).
Conclusions
The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.

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Reviews

Endoscopic treatment for rectal neuroendocrine tumor: which method is better?: Seung Min Hong, Dong Hoon Baek; Clin Endosc 2022;55(4):496-506. Published online July 11, 2022; DOI: https://doi.org/10.5946/ce.2022.115

Abstract PDF PubReader ePub

Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mm without atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probability of patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resection of rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations for technique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopic characteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover, the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resection is the most suitable resection method for rectal NETs of <10 mm, because it is an effective and safe technique that is relatively simple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be considered when the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopic mucosal resection does not work well.

Citations

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Treatment strategy and post‐treatment management of colorectal neuroendocrine tumor
Masau Sekiguchi, Takahisa Matsuda, Yutaka Saito
DEN Open.2024;[Epub] CrossRef
Comparison of endoscopic resection therapies for rectal neuroendocrine tumors
Meijiao Lu, Hongxia Cui, Mingjie Qian, Yating Shen, Jianhong Zhu
Minimally Invasive Therapy & Allied Technologies.2024; : 1. CrossRef
A Review of Colonoscopy in Intestinal Diseases
Seung Hong, Dong Baek
Diagnostics.2023; 13(7): 1262. CrossRef
Treatment of localized well-differentiated rectal neuroendocrine tumors: A focused review
Shigenobu Emoto, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Hiroyuki Matsuzaki, Yuichiro Yokoyama, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Soichiro Ishihara
Formosan Journal of Surgery.2023; 56(3): 73. CrossRef
Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
Soo-Young Na, Seong Jung Kim, Hyoun Woo Kang
International Journal of Gastrointestinal Intervention.2023; 12(3): 105. CrossRef
Endoscopic submucosal dissection coupled with �modified clip coupled with elastic ring� traction removing rectal neuroendocrine tumor
Jing Zhou, Li-Sheng Wang, De-Feng Li, Rui-Yue Shi
Revista Española de Enfermedades Digestivas.2023;[Epub] CrossRef

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Current Treatment Strategy for Superficial Nonampullary Duodenal Epithelial Tumors: Tetsuya Suwa, Kohei Takizawa, Noboru Kawata, Masao Yoshida, Yohei Yabuuchi, Yoichi Yamamoto, Hiroyuki Ono; Clin Endosc 2022;55(1):15-21. Published online September 29, 2021; DOI: https://doi.org/10.5946/ce.2021.141

Abstract PDF PubReader ePub

Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.

Citations

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International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy
Seung Joo Kang, Chung Hyun Tae, Chang Seok Bang, Cheol Min Shin, Young-Hoon Jeong, Miyoung Choi, Joo Ha Hwang, Yutaka Saito, Philip Wai Yan Chiu, Rungsun Rerknimitr, Christopher Khor, Vu Van Khien, Kee Don Choi, Ki-Nam Shim, Geun Am Song, Oh Young Lee
Clinical Endoscopy.2024; 57(2): 141. CrossRef
Underwater Endoscopic Mucosal Resection Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors ≤20 mm
Zhikun Yin, Ji Li, Weilin Yang, Weifeng Huang, Dong Xu, Xiaoyi Lei, Jinyan Zhang
Journal of Clinical Gastroenterology.2023; 57(9): 928. CrossRef
Long-term outcomes of endoscopic resection for duodenal neuroendocrine tumors
Kiyoun Yi, Gwang Ha Kim, Su Jin Kim, Cheol Woong Choi, Moon Won Lee, Bong Eun Lee, Geun Am Song
Scientific Reports.2023;[Epub] CrossRef
Endoscopic management of NADTs
Enrique Pérez-Cuadrado-Robles, Pierre H. Deprez
Endoscopy International Open.2022; 10(06): E733. CrossRef
Duodenaladenome und -karzinome: chirurgische Therapiekonzepte
Michael Ghadimi, Jochen Gaedcke
Allgemein- und Viszeralchirurgie up2date.2022; 16(03): 257. CrossRef
Issues and Prospects of Current Endoscopic Treatment Strategy for Superficial Non-Ampullary Duodenal Epithelial Tumors
Tetsuya Suwa, Masao Yoshida, Hiroyuki Ono
Current Oncology.2022; 29(10): 6816. CrossRef
Duodenaladenome und -karzinome: chirurgische Therapiekonzepte
Michael Ghadimi, Jochen Gaedcke
Onkologie up2date.2022; 4(04): 325. CrossRef

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Original Articles

Efficacy of Underwater Endoscopic Mucosal Resection for Superficial Non-Ampullary Duodenal Epithelial Tumor: Masanori Furukawa, Akira Mitoro, Takahiro Ozutumi, Yukihisa Fujinaga, Keisuke Nakanishi, Koh Kitagawa, Soichiro Saikawa, Sinya Sato, Yasuhiko Sawada, Hiroaki Takaya, Kosuke Kaji, Hideto Kawaratani, Tadashi Namisaki, Kei Moriya, Takemi Akahane, Junichi Yamao, Hitoshi Yoshiji; Clin Endosc 2021;54(3):371-378. Published online February 18, 2021; DOI: https://doi.org/10.5946/ce.2020.147

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic resection (ER) for superficial non-ampullary duodenal epithelial tumors (SNADETs) is challenging. Conventional endoscopic mucosal resection (CEMR) is also problematic due to the anatomical features of the duodenum. We compared the safety and efficacy of underwater endoscopic mucosal resection (UEMR) with those of CEMR through a retrospective analysis.
Methods
Altogether, 44 consecutive patients with 46 SNADETs underwent ER (18 CEMR cases and 28 UEMR cases) between January 2016 and October 2019. We investigated the proportions of en bloc resection, R0 resection, complications, resection time, and total procedure time and compared the outcomes of patients from the CEMR group with those of patients from the UEMR group.
Results
The median tumor size was 8.0 mm (range, 2.0–20.0 mm). The UEMR group showed a higher proportion of en bloc resection (96.4% vs. 72.2%, p<0.05) and significantly lower median resection time and total procedure time (4 min vs. 9.5 min, p<0.05 and 13 min vs. 19 min, p<0.05; respectively) than the CEMR group. No complications were observed. However, two patients treated with piecemeal resection in the CEMR group had residual tumors.
Conclusions
UEMR is a feasible therapeutic option for SNADETs. It can be recommended as a standard treatment.

Citations

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Conventional versus underwater endoscopic resection for superficial non-ampullary duodenal epithelial tumours
Hajime Miyazaki, Osamu Dohi, Tsugitaka Ishida, Mayuko Seya, Katsuma Yamauchi, Hayato Fukui, Takeshi Yasuda, Takuma Yoshida, Naoto Iwai, Toshifumi Doi, Ryohei Hirose, Ken Inoue, Akihito Harusato, Naohisa Yoshida, Kazuhiko Uchiyama, Tomohisa Takagi, Takeshi
Japanese Journal of Clinical Oncology.2024; 54(2): 137. CrossRef
Can underwater endoscopic mucosal resection be an alternative to conventional endoscopic mucosal resection for superficial non‐ampullary duodenal epithelial tumors?
Hidenori Tanaka, Yuji Urabe, Hiroki Takemoto, Kazuki Ishibashi, Hirona Konishi, Yuka Matsubara, Yudai Takehara, Shin Morimoto, Fumiaki Tanino, Noriko Yamamoto, Hajime Teshima, Junichi Mizuno, Issei Hirata, Hirosato Tamari, Akiyoshi Tsuboi, Ken Yamashita,
DEN Open.2024;[Epub] CrossRef
Underwater Endoscopic Mucosal Resection Vs Conventional EMR for Superficial Nonampullary Duodenal Epithelial Tumors in the Western Setting
Rui Morais, José Amorim, Renato Medas, Bernardo Sousa-Pinto, João Santos-Antunes, Romain Legros, Jérémie Albouys, Frédéric Moll, Margarida Marques, Filipe Vilas-Boas, Eduardo Rodrigues-Pinto, Irene Gullo, Fátima Carneiro, Elisa Gravito Soares, Pedro Amaro
Clinical Gastroenterology and Hepatology.2024;[Epub] CrossRef
Underwater versus conventional endoscopic mucosal resection for superficial non-ampullary duodenal epithelial tumors ≤20mm: A systematic review and meta-analysis
Xiu-He Lv, Rong Luo, Qing Lu, Kai Deng, Jin-Lin Yang
Digestive and Liver Disease.2023; 55(6): 714. CrossRef
Underwater Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors: A Systematic Review and Meta-Analysis
Jae Gon Lee, Sang Pyo Lee, Hyun Joo Jang, Sea Hyub Kae
Digestive Diseases and Sciences.2023; 68(4): 1482. CrossRef
A feasibility study comparing gel immersion endoscopic resection and underwater endoscopic mucosal resection for superficial nonampullary duodenal epithelial tumors
Akihiro Miyakawa, Toshio Kuwai, Yukie Sakuma, Manabu Kubota, Akira Nakamura, Ei Itobayashi, Haruhisa Shimura, Yoshio Suzuki, Kenji Shimura
Endoscopy.2023; 55(03): 261. CrossRef
Underwater Endoscopic Mucosal Resection Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors ≤20 mm
Zhikun Yin, Ji Li, Weilin Yang, Weifeng Huang, Dong Xu, Xiaoyi Lei, Jinyan Zhang
Journal of Clinical Gastroenterology.2023; 57(9): 928. CrossRef
Efficacy and safety of underwater endoscopic mucosal resection for ≤20 mm superficial non-ampullary duodenal epithelial tumors: Systematic review and meta-analysis
Jixiang Liu, Shaojie Duan, Yichong Wang, Hongye Peng, Youjia Kong, Shukun Yao
Frontiers in Medicine.2023;[Epub] CrossRef
Underwater versus conventional EMR for nonpedunculated colorectal lesions: a randomized clinical trial
Luciano Lenz, Bruno Martins, Gustavo Andrade de Paulo, Fabio Shiguehissa Kawaguti, Elisa Ryoka Baba, Ricardo Sato Uemura, Carla Cristina Gusmon, Sebastian Naschold Geiger, Renata Nobre Moura, Caterina Pennacchi, Marcelo Simas de Lima, Adriana Vaz Safatle-
Gastrointestinal Endoscopy.2023; 97(3): 549. CrossRef
Endoscopic resection of superficial non‐ampullary duodenal epithelial tumor
Motohiko Kato, Takanori Kanai, Naohisa Yahagi
DEN Open.2022;[Epub] CrossRef
The Application of Underwater Endoscopic Mucosal Resection for Nonampullary Duodenal Adenomas
Xiu-He Lv, Jin-Lin Yang
Clinical Gastroenterology and Hepatology.2022; 20(8): 1884. CrossRef
Utility of underwater EMR for nonpolypoid superficial nonampullary duodenal epithelial tumors ≤20 mm
Kenichiro Okimoto, Daisuke Maruoka, Tomoaki Matsumura, Kengo Kanayama, Naoki Akizue, Yuki Ohta, Takashi Taida, Keiko Saito, Yosuke Inaba, Yohei Kawasaki, Makoto Arai, Jun Kato, Naoya Kato
Gastrointestinal Endoscopy.2022; 95(1): 140. CrossRef
Reply
Yasushi Yamasaki, Noriya Uedo
Clinical Gastroenterology and Hepatology.2022; 20(8): 1884. CrossRef
Appropriate selection of endoscopic resection for superficial nonampullary duodenal adenomas in association with recurrence
Kenichiro Okimoto, Daisuke Maruoka, Tomoaki Matsumura, Kengo Kanayama, Naoki Akizue, Yuki Ohta, Takashi Taida, Keiko Saito, Yosuke Inaba, Yohei Kawasaki, Jun Kato, Naoya Kato
Gastrointestinal Endoscopy.2022; 95(5): 939. CrossRef
Reply to Lv and Yang
Motohiko Kato, Yoji Takeuchi, Shu Hoteya, Tsuneo Oyama, Satoru Nonaka, Shoichi Yoshimizu, Naomi Kakushima, Ken Ohata, Hironori Yamamoto, Yuko Hara, Hisashi Doyama, Osamu Dohi, Yasushi Yamasaki, Hiroya Ueyama, Kengo Takimoto, Koichi Kurahara, Tomoaki Tashi
Endoscopy.2022; 54(05): 523. CrossRef
Endoscopic treatment selection for superficial duodenal tumors: pay attention to small lesions
Xiu-He Lv, Jin-Lin Yang
Endoscopy.2022; 54(05): 522. CrossRef
Resectability of underwater endoscopic mucosal resection for duodenal tumor: A single‐center, retrospective pilot study
Yosuke Toya, Masaki Endo, Masanao Yamazato, Shun Yamada, Tomo Kumei, Minami Hirai, Makoto Eizuka, Toshifumi Morishita, Risaburo Akasaka, Shunichi Yanai, Noriyuki Uesugi, Tamotsu Sugai, Takayuki Matsumoto
Journal of Gastroenterology and Hepatology.2021; 36(11): 3191. CrossRef

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The Use of Endoscopic Clipping in Preventing Delayed Complications after Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumors: Jee Young An, Byung-Wook Kim, Joon Sung Kim, Jae-Myung Park, Tae Ho Kim, Jaesin Lee; Clin Endosc 2021;54(4):563-569. Published online November 24, 2020; DOI: https://doi.org/10.5946/ce.2020.109

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic resection (ER) has recently been accepted as the standard treatment modality for superficial nonampullary duodenal tumors (SNADTs). However, the procedure can cause adverse events such as perforation and bleeding. This study aimed to investigate the efficacy of prophylactic clipping in the prevention of delayed complications.
Methods
A retrospective review of the medical records of patients who underwent ER for SNADT from 3 centers was performed. Patients were divided into 2 groups: the immediate clipping group (ICG) and the no clipping group (NCG). Various baseline characteristics and factors associated with the appearance of delayed complications, such as size of the lesion, tumor location, histologic type, and co-morbidities, were compared between the two groups.
Results
A total of 99 lesions from 99 patients were included in this study. Fifty-two patients were allocated into ICG and 47 patients were allocated into NCG. Delayed bleeding occurred in 1 patient from ICG and in 8 patients from NCG. Delayed perforation occurred in 1 patient from ICG and in 3 patients from NCG. There were no procedure-related deaths in both groups.
Conclusions
Although the use of endoscopic clipping seemed to reduce the risk of developing delayed complications, further studies using a prospective design is required.

Citations

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The Effect of Tegoprazan on the Treatment of Endoscopic Resection-Induced Artificial Ulcers: A Multicenter, Randomized, Active-Controlled Study
Byung-Wook Kim, Jong Jae Park, Hee Seok Moon, Wan Sik Lee, Ki-Nam Shim, Gwang Ho Baik, Yun Jeong Lim, Hang Lak Lee, Young Hoon Youn, Jun Chul Park, In-Kyung Sung, Hyunsoo Chung, Jeong Seop Moon, Gwang Ha Kim, Su Jin Hong, Hyuk Soon Choi
Gut and Liver.2024; 18(2): 257. CrossRef
Endoscopic diagnosis and treatment of superficial non-ampullary duodenal epithelial tumors: A review
Zheng Zhao, Yue Jiao, Shuyue Yang, Anni Zhou, Guiping Zhao, Shuilong Guo, Peng Li, Shutian Zhang
Journal of Translational Internal Medicine.2023; 11(3): 206. CrossRef
Long-term outcomes of endoscopic resection for duodenal neuroendocrine tumors
Kiyoun Yi, Gwang Ha Kim, Su Jin Kim, Cheol Woong Choi, Moon Won Lee, Bong Eun Lee, Geun Am Song
Scientific Reports.2023;[Epub] CrossRef
Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment
Giuseppe Galloro, Angelo Zullo, Gaetano Luglio, Alessia Chini, Donato Alessandro Telesca, Rosa Maione, Matteo Pollastro, Giovanni Domenico De Palma, Raffaele Manta
Clinical Endoscopy.2022; 55(3): 339. CrossRef
Endoscopic Closure After Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumors
Satoshi Tanabe, Takuya Wada
Clinical Endoscopy.2021; 54(4): 453. CrossRef

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Case Report

Successful Endoscopic Resection of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Unresponsive to Helicobacter pylori Eradication Therapy: Jeongmin Choi; Clin Endosc 2022;55(1):136-140. Published online November 16, 2020; DOI: https://doi.org/10.5946/ce.2020.232

Abstract PDF PubReader ePub

Eradication of Helicobacter pylori is the first-line treatment for gastric mucosa-associated lymphoid tissue (MALT) lymphomas; however, lesions may persist in 20% of patients after initial treatment, thereby necessitating the use of an additional therapeutic approach. Other treatment options include radiation therapy, chemotherapy, endoscopic resection, rituximab therapy, or watchful waiting. We present a case of localized gastric MALT lymphoma that did not respond to H. pylori eradication therapy. The patient waited for 12 months but the tumor showed no signs of regression endoscopically. Histologic examination revealed residual MALT lymphoma. The tumor was then successfully treated using endoscopic submucosal dissection and the patient remained disease-free for 4 years. To our knowledge, this is the first case in which a gastric MALT lymphoma was treated with endoscopic submucosal dissection. In conclusion, endoscopic resection may be recommended as second-line therapy for properly selected patients with gastric MALT lymphoma as it is effective and minimally invasive.

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A Common Symptom With an Uncommon Diagnosis: A Case of Primary Esophageal Diffuse Large B-cell Lymphoma
Shruthi Narasimha, Rasiq Zackria, Jonathan Hughes, Vijay Jayaraman
Cureus.2024;[Epub] CrossRef
A Case of Esophageal MALT Lymphoma Mimicking a Subepithelial Tumor
Ha Eun Lee, Gwang Ha Kim, Min Ji Kim, Kyung Bin Kim, Dong Chan Joo, Hye Kyung Jeon, Moon Won Lee, Bong Eun Lee
The Korean Journal of Gastroenterology.2024; 83(4): 157. CrossRef
Clinical Management of Patients with Gastric MALT Lymphoma: A Gastroenterologist’s Point of View
Tamara Matysiak-Budnik, Kateryna Priadko, Céline Bossard, Nicolas Chapelle, Agnès Ruskoné-Fourmestraux
Cancers.2023; 15(15): 3811. CrossRef
Endoscopic Submucosal Dissection for Treatment of Localized Gastric Mucosa-associated Lymphoid Tissue Lymphoma: A Case Series
Jun-young Seo, Kee Don Choi, In Hye Song, Young Soo Park, Hee Kyong Na, Ji Yong Ahn, Jeong Hoon Lee, Kee Wook Jung, Do Hoon Kim, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(3): 188. CrossRef
Bacteria-Mediated Oncogenesis and the Underlying Molecular Intricacies: What We Know So Far
Shashanka K. Prasad, Smitha Bhat, Dharini Shashank, Akshatha C. R., Sindhu R., Pornchai Rachtanapun, Devananda Devegowda, Prasanna K. Santhekadur, Sarana Rose Sommano
Frontiers in Oncology.2022;[Epub] CrossRef
Primary Esophageal Lymphoma: Clinical Experience in Diagnosis and Treatment
Junchi Qu, Yanyan Zhuang, Dandan Zheng, Fengting Huang, Shineng Zhang
Cureus.2021;[Epub] CrossRef

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Review

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer: Chan Hyuk Park, Dong-Hoon Yang, Jong Wook Kim, Jie-Hyun Kim, Ji Hyun Kim, Yang Won Min, Si Hyung Lee, Jung Ho Bae, Hyunsoo Chung, Kee Don Choi, Jun Chul Park, Hyuk Lee, Min-Seob Kwak, Bun Kim, Hyun Jung Lee, Hye Seung Lee, Miyoung Choi, Dong-Ah Park, Jong Yeul Lee, Jeong-Sik Byeon, Chan Guk Park, Joo Young Cho, Soo Teik Lee, Hoon Jai Chun; Clin Endosc 2020;53(2):142-166. Published online March 30, 2020; DOI: https://doi.org/10.5946/ce.2020.032

Abstract PDF Supplementary Material PubReader ePub

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

Citations

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Helicobacter pylori Treatment and Gastric Cancer Risk After Endoscopic Resection of Dysplasia: A Nationwide Cohort Study
Hae Won Yoo, Su Jin Hong, Shin Hee Kim
Gastroenterology.2024; 166(2): 313. CrossRef
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Original Articles

Efficacy and Safety of Endoscopic Treatment for Gastrointestinal Stromal Tumors in the Upper Gastrointestinal Tract: Cicilia Marcella, Shakeel Sarwar, Hui Ye, Rui Hua Shi; Clin Endosc 2020;53(4):458-465. Published online March 17, 2020; DOI: https://doi.org/10.5946/ce.2019.121

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic treatment (ET) has been applied for decades to treat subepithelial tumors, including gastrointestinal stromal tumors (GISTs). However, the efficacy of ET remains debatable. In this study, we evaluated the efficacy and safety of ET for GISTs in the upper gastrointestinal tract.
Methods
This retrospective single-center study included 97 patients who underwent ET. All patients were enrolled from July 2014 to July 2018. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time, total cost, and follow-up were investigated and analyzed.
Results
Our study achieved 100% en bloc resection and 77.4% (72/93) R0 resection. The most common location was the fundus with a mean tumor size of 2.1±1.43 cm. The mean age, procedure time, hospital stay, and cost were 59.7±11.29 years, 64.7±35.23 minutes, 6.8 days, and 5,337 dollars, respectively. According to National Institutes of Health classification, 63 (64.9%), 26 (26.8%), 5 (5.2%), and 3 (3.1%) patients belonged to the very low, low, intermediate, and high risk classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 21.3±13.0 months showed no recurrence or metastasis.
Conclusions
ET is effective and safe for curative removal of GISTs in the upper gastrointestinal tract, and it can be a treatment of choice for patients with no metastasis.

Citations

Citations to this article as recorded by

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Bleeding after Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis: A Multicenter Propensity Score-Matched Analysis: In Kyung Yoo, Chan Gyoo Kim, Young Ju Suh, Younkyung Oh, Gwang Ho Baik, Sun Moon Kim, Young Dae Kim, Chul-Hyun Lim, Jung Won Jeon, Su Jin Hong, Byoung Wook Bang, Joon Sung Kim, Jun-Won Chung; Clin Endosc 2020;53(4):452-457. Published online October 25, 2019; DOI: https://doi.org/10.5946/ce.2019.107

Abstract PDF PubReader ePub

Background
/Aims: Frequent bleeding after endoscopic resection (ER) has been reported in patients with end-stage renal disease (ESRD). We aimed to evaluate the association and clinical significance of bleeding with ER in ESRD patients on dialysis.
Methods
Between February 2008 and December 2018, 7,571 patients, including 47 ESRD patients on dialysis who underwent ER for gastric neoplasia, were enrolled. A total of 47 ESRDpatients on dialysis were propensity score-matched 1:10 to 470 non-ESRD patients, to adjust for between-group differences in variables such as age, sex, comorbidities, anticoagulation use, tumor characteristics, and ER method. Matching was performed using an optimal matching algorithm. For the matched data, clustered comparisons were performed using the generalized estimating equation method. Medical records were retrospectively reviewed. Frequency and outcomes of post-ER bleeding were evaluated.
Results
Bleeding was more frequent in the ESRD with dialysis group than in the non-ESRD group. ESRD with dialysis conferred a significant risk of post-ER bleeding (odds ratio, 6.1; 95% confidence interval, 2.7–13.6; p<0.0001). All post-ER bleeding events were controlled using endoscopic hemostasis except in 1 non-ESRD case that needed surgery.
Conclusions
ESRD with dialysis confers a bleeding risk after ER. However, all bleeding events could be managed endoscopically without sequelae. Concern about bleeding should not stop endoscopists from performing ER in ESRD patients on dialysis.

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Effect of renal insufficiency on the short‐ and long‐term outcomes of endoscopic submucosal dissection for early gastric cancer: Propensity score‐matched analysis
Tae‐Se Kim, Byung‐Hoon Min, Sun‐Young Baek, Kyunga Kim, Yang Won Min, Hyuk Lee, Poong‐Lyul Rhee, Jae J. Kim, Jun Haeng Lee
Digestive Endoscopy.2023; 35(7): 869. CrossRef
Safeness of Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis
Sun-Jin Boo
Clinical Endoscopy.2020; 53(4): 381. CrossRef

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2 Web of Science
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Case Reports

Colonic Intramucosal Cancer in the Interposed Colon Treated with Endoscopic Mucosal Resection: A Case Report and Review of Literature: Seung-Ho Baek, Jang-Ho Lee, Dong Ryeol Yoo, Hye Yeong Kim, Meihua Jin, Ah-reum Jang, Dong-Hoon Yang, Jeong-Sik Byeon; Clin Endosc 2019;52(4):377-381. Published online July 30, 2019; DOI: https://doi.org/10.5946/ce.2018.129

Abstract PDF Supplementary Material PubReader ePub

Colon interposition is a surgical procedure used for maintenance of luminal conduit after esophagectomy. Although epithelial neoplasia, such as adenoma and adenocarcinoma, may develop in the interposed colon, there are only few case reports on the condition. Due to the rarity of this condition, there is no definite consensus on recommending screening endoscopy for the early detection of neoplasia in the interposed colons. Here, we report a case of intramucosal adenocarcinoma in an interposed colon. Initial endoscopic resection for this tumor failed to accomplish complete resection. A subsequent endoscopic resection was performed 1 month later and complete resection was achieved. Based on our experience and recommendation on screening endoscopy for gastric cancer in Korea, we suggest that regular screening esophagogastroduodenoscopies should be performed following esophagectomy to detect early neoplasia in the stomach and interposed colon and avoid adverse results induced by delayed detection.

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The presence of adenocarcinoma of the right colon and polyp in colonic graft in a female patient with colon interposition due to caustic stricture of the esophagus in childhood
Stojan Latincic, Maja Pavlov, Jovica Vasiljevic, Dragan Vasin, Milena Papovic
Srpski arhiv za celokupno lekarstvo.2024; 152(1-2): 71. CrossRef

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1 Crossref

A Case of a Bleeding Duodenal Lipoma Successfully Controlled by Endoscopic Resection: Seo Yeon Gwak, Mi Kyung Lee, Yong Kang Lee; Clin Endosc 2020;53(2):236-240. Published online July 24, 2019; DOI: https://doi.org/10.5946/ce.2019.035

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This is a case report of successful endoscopic resection (ER) of a bleeding duodenal lipoma. An 85-year-old woman who was diagnosed with asymptomatic subepithelial tumor of the duodenum 3 years ago visited the emergency room with hematemesis and was admitted to our hospital. Emergent esophagogastroduodenoscopy revealed bleeding from an ulcer on the superior aspect of a subepithelial tumor measuring about 20 mm in diameter, at the superior duodenal angle. The ulcer was in the active stage (A1), with a visible vessel. The bleeding was controlled by ER of the tumor using a snare. The final pathological diagnosis was duodenal lipoma with mucosal ulceration. The patient showed no signs of bleeding for 10 days after the procedure; subsequently, she was discharged and followed up for regular checkups.

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Endoscopically resected duodenal lipoma as an uncommon cause of upper gastrointestinal bleeding: a case report
Dong Chan Joo, Gwang Ha Kim, Bong Eun Lee, Moon Won Lee, Cheolung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef

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1 Crossref

A Rare Case of Lymph Node Metastasis from Early Gastric Cancer: Takaaki Yoshikawa, Yoshio Kadokawa, Masaya Ohana, Akihisa Fukuda, Hiroshi Seno; Clin Endosc 2019;52(4):369-372. Published online October 5, 2018; DOI: https://doi.org/10.5946/ce.2018.130

Abstract PDF PubReader ePub: Gastric cancers that fulfill the Japanese criteria for curative endoscopic resection show a low risk of lymph node (LN) metastasis. Here, we report a case of LN metastasis from early gastric cancer that fulfilled the curative criteria. A 74-year-old Japanese woman was referred to our hospital for treatment of early gastric cancer identified at the site of a hyperplastic polyp that had been diagnosed 10 years prior to presentation. Contrast-enhanced computed tomography did not show any lymphadenopathy and laparoscopy-assisted distal gastrectomy was performed. Histopathological examination revealed a predominantly moderately differentiated adenocarcinoma that measured 15 mm in size and was confined to the mucosa. However, a single metastatic regional LN was observed. A few cancer cells showed positive staining for alpha-fetoprotein. It should be noted that early gastric cancer can be accompanied by LN metastasis even if it fulfills the criteria for curative endoscopic resection.

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Original Article

Long-Term Survival and Tumor Recurrence in Patients with Superficial Esophageal Cancer after Complete Non-Curative Endoscopic Resection: A Single-Center Case Series: Ji Wan Lee, Charles J. Cho, Do Hoon Kim, Ji Yong Ahn, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Sook Ryun Park, Hyun Joo Lee, Yong Hee Kim, Gin Hyug Lee, Hwoon-Yong Jung, Sung-Bae Kim, Jong Hoon Kim, Seung-Il Park; Clin Endosc 2018;51(5):470-477. Published online June 1, 2018; DOI: https://doi.org/10.5946/ce.2018.025

Abstract PDF PubReader ePub

Background
/Aims: To report the long-term survival and tumor recurrence outcomes in patients with superficial esophageal cancer (SEC) after complete non-curative endoscopic resection (ER).
Methods
We retrieved ER data for 24 patients with non-curatively resected SEC. Non-curative resection was defined as the presence of submucosal and/or lymphovascular invasion on ER pathology. Relevant clinical and tumor-specific parameters were reviewed.
Results
The mean age of the 24 study patients was 66.3±8.3 years. Ten patients were closely followed up without treatment, while 14 received additional treatment. During a mean follow-up of 59.0±33.2 months, the 3- and 5-year survival rates of all cases were 90.7% and 77.6%, respectively. The 5-year overall survival rates were 72.9% in the close observation group and 82.1% in the additional treatment group (p=0.958). The 5-year cumulative incidences of all cases of recurrence (25.0% vs. 43.3%, p=0.388), primary EC recurrence (10.0% vs. 16.4%, p=0.558), and metachronous EC recurrence (16.7% vs. 26.7%, p=0.667) were similar between the two groups.
Conclusions
Patients with non-curatively resected SEC showed good long-term survival outcomes. Given the similar oncologic outcomes, close observation may be an option with appropriate caution taken for patients who are medically unfit to receive additional therapy.

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Close Observation versus Additional Surgery after Noncurative Endoscopic Resection of Esophageal Squamous Cell Carcinoma
Byeong Geun Song, Ga Hee Kim, Charles J. Cho, Hyeong Ryul Kim, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Ho June Song, Yong-Hee Kim, Jun Haeng Lee, Hwoon-Yong Jung, Jae Ill Zo, Young Mog Shim
Digestive Surgery.2021; 38(3): 247. CrossRef
Non-Curative Endoscopic Resection for Superficial Esophageal Cancer
Eun Hye Kim, Jun Chul Park
Clinical Endoscopy.2018; 51(5): 399. CrossRef

5,702 View
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Focused Review Series: The New Era of Therapeutic Endoscopy - Endoscopic Submucosal Surgery

Endoscopic Treatment of Subepithelial Tumors: Su Young Kim, Kyoung-Oh Kim; Clin Endosc 2018;51(1):19-27. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.020

Abstract PDF PubReader ePub

Gastrointestinal subepithelial tumors (SETs) are generally found during endoscopy and their incidence has gradually increased. Although the indications for the endoscopic treatment of patients with SETs remain to be established, the feasibility and safety of endoscopic dissection, including the advantages of this method compared with surgical treatment, have been validated in many studies. The development of endoscopic techniques, such as endoscopic submucosal dissection, endoscopic enucleation, endoscopic excavation, endoscopic submucosal tunnel dissection, submucosal tunnel endoscopic resection, and endoscopic full-thickness resection has enabled the removal of SETs while reducing the occurrence of complications. Here, we discuss the endoscopic treatment of patients with SETs, outcomes for endoscopic treatment, and procedure-related complications. We also consider the advantages and disadvantages of the various endoscopic techniques.

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Chun-Yan Li, Yi-Feng Wang, Li-Kang Luo, Xiao-Jun Yang
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Cold snare endoscopic resection for subepithelial tumors of the upper third of the esophagus
Xiaosan Hu, Lifeng Zhou, Jian Chen, Yunlin Yue
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An Atypical Presentation of a Colonic Lipoma: Avoiding Surgery with a Deeper Endoscopic Look
Mafalda João, Inês Cunha, Elisa Gravito-Soares, Marta Gravito-Soares, Pedro Amaro, Pedro Figueiredo
GE - Portuguese Journal of Gastroenterology.2022; 29(1): 45. CrossRef
Endoscopic Resection of Upper Gastrointestinal Subepithelial Tumours: Our Clinical Experience and Results
Mehmet Zeki Buldanlı, Oktay Yener
Prague Medical Report.2022; 123(1): 20. CrossRef
Natural History of Asymptomatic Esophageal Subepithelial Tumors of 30 mm or Less in Size
Seokin Kang, Do Hoon Kim, Yuri Kim, Dongsub Jeon, Hee Kyong Na, Jeong Hoon Lee, Ji Yong Ahn, Kee Wook Jung, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
Journal of Korean Medical Science.2022;[Epub] CrossRef
Risk stratification in patients with upper gastrointestinal submucosal tumors undergoing submucosal tunnel endoscopic resection
Yong Lv, Shaohua Li, Xiuhe Lv, Qing Liu, Yu Zheng, Yang Su, Changbin Yang, Yanglin Pan, Liping Yao, Huahong Xie
Frontiers in Medicine.2022;[Epub] CrossRef
Endoscopic versus surgical resection in the management of gastric schwannomas
Ya-qi Zhai, Ning-li Chai, Wen-gang Zhang, Hui-kai Li, Zhong-sheng Lu, Xiu-xue Feng, Sheng-zhen Liu, En-qiang Linghu
Surgical Endoscopy.2021; 35(11): 6132. CrossRef
Endoscopic Full-Thickness Resection for Gastric Subepithelial Lesions Arising from the Muscularis Propria
Ah Lon Jung, Sang Wook Park, Gun Young Hong, Hyeong Chul Moon, Seo Joon Eun
Clinical Endoscopy.2021; 54(1): 131. CrossRef
A Review of Endoscopic Full-thickness Resection, Submucosal Tunneling Endoscopic Resection, and Endoscopic Submucosal Dissection for Resection of Subepithelial Lesions
Vicky H. Bhagat, Marina Kim, Michel Kahaleh
Journal of Clinical Gastroenterology.2021; 55(4): 309. CrossRef
A modified endoscopic full thickness resection for gastric subepithelial tumors from muscularis propria layer: Novel method
Jung Min Lee, In Kyung Yoo, Sung Pyo Hong, Joo Young Cho, Young Kwan Cho
Journal of Gastroenterology and Hepatology.2021; 36(9): 2558. CrossRef
Endoscopic resection of esophageal and gastric submucosal tumors from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation: A systematic review and meta-analysis
Fernando Lopes Ponte Neto, Diogo Turiani Hourneaux de Moura, Vitor Massaro Takamatsu Sagae, Igor Braga Ribeiro, Fabio Catache Mancini, Mateus Bond Boghossian, Thomas R. McCarty, Nelson Tomio Miyajima, Edson Ide, Wanderley Marques Bernardo, Eduardo Guimarã
Surgical Endoscopy.2021; 35(12): 6413. CrossRef
The retrospective comparison between submucosal tunneling endoscopic resection and endoscopic submucosal excavation for managing esophageal submucosal tumors originating from the muscularis propria layer
Yingtong Chen, Min Wang, Lili Zhao, He Chen, Li Liu, Xiang Wang, Zhining Fan
Surgical Endoscopy.2020; 34(1): 417. CrossRef
Ligation-assisted endoscopic mucosal resection for esophageal granular cell tumors is safe and effective
Shria Kumar, Vinay Chandrasekhara, Michael L Kochman, Nuzhat Ahmad, Sara Attalla, Immanuel K Ho, David L Jaffe, Peter J Lee, Kashyap V Panganamamula, Monica Saumoy, Danielle Fortuna, Gregory G Ginsberg
Diseases of the Esophagus.2020;[Epub] CrossRef
Endoscopic Full Thickness Resection for Gastrointestinal Tumors - Challenges and Solutions
Hung Leng Kaan, Khek Yu Ho
Clinical Endoscopy.2020; 53(5): 541. CrossRef
Gestielter submuköser Tumor im Jejunum
Tanja Miltner
Der Gastroenterologe.2019; 14(6): 470. CrossRef
Submucosal Tunnel Endoscopic Resection for Esophageal Submucosal Tumors: A Multicenter Study
Sufang Tu, Silin Huang, Guohua Li, Xiaowei Tang, Haitao Qing, Qiaoping Gao, Jingwen Fu, Guoping Du, Wei Gong
Gastroenterology Research and Practice.2018; 2018: 1. CrossRef

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Focused Review Series: Current Status of Endoscopy in the Management of Inflammatory Bowel Disease

Endoscopic Therapeutic Approach for Dysplasia in Inflammatory Bowel Disease: Sung Noh Hong; Clin Endosc 2017;50(5):437-445. Published online September 29, 2017; DOI: https://doi.org/10.5946/ce.2017.132

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Long-standing intestinal inflammation in patients with inflammatory bowel disease (IBD) induces dysplastic change in the intestinal mucosa and increases the risk of subsequent colorectal cancer. The evolving endoscopic techniques and technologies, including dye spraying methods and high-definition images, have been replacing random biopsies and have been revealed as more practical and efficient for detection of dysplasia in IBD patients. In addition, they have potential usefulness in detailed characterization of lesions and in the assessment of endoscopic resectability. Most dysplastic lesions without an unclear margin, definite ulceration, non-lifting sign, and high index of malignant change with suspicion for lymph node or distant metastases can be removed endoscopically. However, endoscopic resection of dysplasia in chronic IBD patients is usually difficult because it is often complicated by submucosal fibrosis. In patients with dysplasias that demonstrate submucosa fibrosis or a large size (≥20 mm), endoscopic submucosal dissection (ESD) or ESD with snaring (simplified or hybrid ESD) is an alternative option and may avoid a colectomy. However, a standardized endoscopic therapeutic approach for dysplasia in IBD has not been established yet, and dedicated specialized endoscopists with interest in IBD are needed to fully investigate recent emerging techniques and technologies.

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Considerations for Colorectal Neoplasia Detection in Inflammatory Bowel Disease Clinical Trials
Mira M. Yang, Keith Usiskin, Harris A. Ahmad, Shabana Ather, Antoine Sreih, James B. Canavan, Francis A. Farraye, Christopher Ma
Digestive Diseases.2024; 42(1): 12. CrossRef
Beyond the SCENIC route: updates in chromoendoscopy and dysplasia screening in patients with inflammatory bowel disease
Loren Galler Rabinowitz, Nikhil A. Kumta, James F. Marion
Gastrointestinal Endoscopy.2022; 95(1): 30. CrossRef
Elevating the Technique: Resecting Complex Dysplastic Lesions of the Colon in Patients with Inflammatory Bowel Disease
Eshandeep S. Boparai, Fernando S. Velayos, Abhik Roy, Carolyn Li, Ahmed S. Alkoraishi, Craig A. Munroe
Digestive Diseases and Sciences.2020; 65(1): 78. CrossRef
Role of interventional inflammatory bowel disease in the era of biologic therapy: a position statement from the Global Interventional IBD Group
Bo Shen, Gursimran Kochhar, Udayakumar Navaneethan, Xiuli Liu, Francis A. Farraye, Yago Gonzalez-Lama, David Bruining, Darrell S. Pardi, Martin Lukas, Martin Bortlik, Kaicun Wu, Ajit Sood, David A. Schwartz, William J. Sandborn, Roger Charles, Yan Chen, M
Gastrointestinal Endoscopy.2019; 89(2): 215. CrossRef
Management of Inflammatory Bowel Disease–Associated Dysplasia in the Modern Era
Shailja C. Shah, Steven H. Itzkowitz
Gastrointestinal Endoscopy Clinics of North America.2019; 29(3): 531. CrossRef

7,286 View
181 Download
4 Web of Science
5 Crossref

Review

Metachronous Gastric Cancer Following Curative Endoscopic Resection of Early Gastric Cancer: Seiichiro Abe, Ichiro Oda, Takeyoshi Minagawa, Masau Sekiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Amit Bhatt, Yutaka Saito; Clin Endosc 2018;51(3):253-259. Published online September 18, 2017; DOI: https://doi.org/10.5946/ce.2017.104

Abstract PDF PubReader ePub

This review article summarizes knowledge about metachronous gastric cancer (MGC) occurring after curative endoscopic resection (ER) of early gastric cancer (EGC), treatment outcomes of patients who developed MGC, and efficacy of Helicobacter pylori eradication to prevent MGC. The incidence of MGC following curative ER increases over time and is higher than in patients undergoing gastrectomy. Increasing age and multifocal EGC are independent risk factors for developing MGC. An MGC following curative ER is usually a small (<20 mm) and differentiated intramucosal cancer. Most MGC lesions are found at an early stage on semiannual or annual surveillance endoscopy and are successfully treated by further ER, with excellent long-term outcomes. Eradication of H. pylori may reduce the risk of MGC following ER of EGC, but further prospective studies with long-term outcomes are required. Surveillance endoscopy following gastric ER should be continued indefinitely, due to the risk of MGC even after successful H. pylori eradication. Risk stratification and tailored endoscopic surveillance schedules need to be developed.

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Impact of endoscopy intervals on metachronous gastric cancer after endoscopic submucosal dissection: Comparison between 1 year and half‐a‐year
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High risk of multiple gastric cancers in Japanese individuals with Lynch syndrome
Nobuhiko Kanaya, Thijs A. van Schaik, Hideki Aoki, Yumiko Sato, Fumitaka Taniguchi, Kunitoshi Shigeyasu, Kokichi Sugano, Kiwamu Akagi, Hideyuki Ishida, Kohji Tanakaya
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Risk assessment of metachronous gastric cancer development using OLGA and OLGIM systems after endoscopic submucosal dissection for early gastric cancer: a long-term follow-up study
Yun Suk Na, Sang Gyun Kim, Soo-Jeong Cho
Gastric Cancer.2023; 26(2): 298. CrossRef
Metachronous lesions after gastric endoscopic submucosal dissection: first assessment of the FAMISH prediction score
Andreia Rei, Raquel Ortigão, Mariana Pais, Luís P. Afonso, Pedro Pimentel-Nunes, Mário Dinis-Ribeiro, Diogo Libânio
Endoscopy.2023; 55(10): 909. CrossRef
Variation in the rate of detection of minute and small early gastric cancers at diagnostic endoscopy may reflect the performance of individual endoscopists
Daisuke Murakami, Masayuki Yamato, Yuji Amano, Takayoshi Nishino, Makoto Arai
BMJ Open Gastroenterology.2023; 10(1): e001143. CrossRef
Decision to perform additional surgery after non-curative endoscopic submucosal dissection for gastric cancer based on the risk of lymph node metastasis: a long-term follow-up study
Seunghan Lee, Sang Gyun Kim, Soo-Jeong Cho
Surgical Endoscopy.2023; 37(10): 7738. CrossRef
Helicobacter pylori Eradication Can Reverse Rho GTPase Expression in Gastric Carcinogenesis
Jue Lie Kim, Sang Gyun Kim, Enerelt Natsagdorj, Hyunsoo Chung, Soo-Jeong Cho
Gut and Liver.2023; 17(5): 741. CrossRef
Risk assessment of metachronous gastric cancer after endoscopic submucosal dissection based on endoscopic intestinal metaplasia
Chino Iizuka, Soichiro Sue, Sho Onodera, Aya Ikeda, Ryosuke Ikeda, Yoshihiro Goda, Kuniyasu Irie, Hiroaki Kaneko, Shin Maeda
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Masao Yoshida, Kohei Takizawa, Noriaki Hasuike, Hiroyuki Ono, Narikazu Boku, Tomohiro Kadota, Junki Mizusawa, Ichiro Oda, Naohiro Yoshida, Yusuke Horiuchi, Kingo Hirasawa, Yoshinori Morita, Yoshinobu Yamamoto, Manabu Muto, Masao Yoshida, Kohei Takizawa, H
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Therapeutic approach to non-curative resection after endoscopic treatment in early gastric cancer
Eun Jeong Gong, Chang Seok Bang
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Assessment of Outcomes From 1-Year Surveillance After Detection of Early Gastric Cancer Among Patients at High Risk in Japan
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Shuhei Unno, Kimihiro Igarashi, Hiroaki Saito, Dai Hirasawa, Toru Okuzono, Yukari Tanaka, Masato Nakahori, Tomoki Matsuda
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Shan-Shan Xu, Ning-Li Chai, Xiao-Wei Tang, En-Qiang Linghu, Sha-Sha Wang, Bao Li
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Moon Won Lee, Gwang Ha Kim
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Jue Lie Kim, Sang Gyun Kim, Jung Kim, Jae Yong Park, Hyo-Joon Yang, Hyun Ju Kim, Hyunsoo Chung
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Tommaso Zurleni, Michele Altomare, Giovanni Serio, Filippo Catalano
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Hyun Ju Kim, Yun Jin Kim, Seung In Seo, Woon Geon Shin, Chan Hyuk Park
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Leonardo Henry Eusebi, Andrea Telese, Giovanni Marasco, Franco Bazzoli, Rocco Maurizio Zagari
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Gwang Ha Kim
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Original Article

Can Endoscopic Ulcerations in Early Gastric Cancer Be Clearly Defined before Endoscopic Resection? A Survey among Endoscopists: Sung Min Park, Byung-Wook Kim, Joon Sung Kim, Young Wook Kim, Gi Jun Kim, Seung Ji Ryu; Clin Endosc 2017;50(5):473-478. Published online April 24, 2017; DOI: https://doi.org/10.5946/ce.2016.143

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Background
/Aims: Early gastric cancer (EGC) with ulcerations can be treated via endoscopic resection (ER) when it is differentiated pathologically, limited to the mucosa, and <3 cm in diameter. The presence of ulceration is a key factor in deciding treatment strategies and is usually diagnosed during endoscopic examination. The aim of this study was to evaluate whether ulcerations in EGC can be clearly defined among endoscopists and which factors are related to the differences.
Methods
A survey questionnaire, composed of demographic features and endoscopic images of seven patients with EGC, was presented to the endoscopists via e-mail. The endoscopists were asked whether such patients have ulcerations in the lesions.
Results
The questionnaires were e-mailed to 197 endoscopists, and 103 doctors replied. The presence of an endoscopic ulceration was defined differently among the endoscopists, depending on the duration of endoscopic practice and the experience of endoscopic submucosal dissection (ESD). The differences were especially high in the lesions without mucosal breaks and converging folds, which were expected to be viewed as non-ulcerative.
Conclusions
Before ER, endoscopic ulcerations in EGC must be reviewed by experienced endoscopists to reduce overestimations, and adequate educational programs for trainees should be established.

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Reviews

Evaluation and Endoscopic Management of Esophageal Submucosal Tumor: Weon Jin Ko, Ga Won Song, Joo Young Cho; Clin Endosc 2017;50(3):250-253. Published online November 7, 2016; DOI: https://doi.org/10.5946/ce.2016.109

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Submucosal tumors (SMTs) originate from tissues that constitute the submucosal layer and muscularis propria, and are covered by normal mucosa. Esophageal SMTs are rare, accounting for <1% of all esophageal tumors. However, the recent widespread use of endoscopy has led to a rapid increase in incidental detection of SMTs in Korea. Esophageal SMTs are benign in ≥90% of cases, but the possibility of malignancies such as gastrointestinal stromal tumor and malignant leiomyosarcoma still exists. Therefore, patients undergo resection in the presence of symptoms or the possibility of a malignant tumor. For resection of esophageal SMTs, surgical resection was the only option available in case of possible malignancy, but minimally invasive surgery by endoscopic resection is becoming more preferable to surgical resection with the development of endoscopic ultrasonography, endoscopic techniques, and other devices.

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Endoscopic Submucosal Dissection for Early Gastric Cancers with Uncommon Histology: Gwang Ha Kim; Clin Endosc 2016;49(5):434-437. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.127

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Endoscopic submucosal dissection (ESD) enables en bloc curative resection of early gastric cancers (EGCs) with a negligible risk of lymph node metastasis (LNM). Although ESD for EGCs with absolute and expanded indications is safe, the results differ between EGCs with specialized and common histologies. EGC with papillary adenocarcinoma is a differentiated-type adenocarcinoma. At present, it is treated with ESD according to the same criteria as other differentiated-type adenocarcinomas. The LNM rate under the current indication criteria is high, and over half of the patients who undergo ESD as a primary treatment for EGC with papillary adenocarcinoma achieve an out-of-ESD result. Gastric carcinoma with lymphoid stroma in EGC has a low LNM rate and a favorable outcome, despite deep submucosal invasion. Patients with this gastric cancer subtype may be good candidates for ESD, even with deep submucosal invasion. Large-scale prospective multi-center studies with longer follow-up periods are needed to set proper ESD criteria for these tumors. Clinicians should be aware of these disease entities and ESD should be more carefully considered for EGCs with papillary adenocarcinoma and gastric carcinoma with lymphoid stroma.

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Interpretation of Pathologic Margin after Endoscopic Resection of Gastrointestinal Stromal Tumor: Sang Gyun Kim; Clin Endosc 2016;49(3):229-231. Published online April 7, 2016; DOI: https://doi.org/10.5946/ce.2016.035

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Interpretation of the pathologic margin of a specimen from a resected tumor is important because local recurrence can be predicted by the presence of tumor cells in the resection margin. Although a sufficient resection margin is recommended in the resection of gastrointestinal adenocarcinoma, it is not usually regarded strictly in cases of mesenchymal tumor, especially gastrointestinal stromal tumor (GIST), because the tumor is usually encapsulated or well demarcated, and not infiltrative. Therefore, margin positivity is not rare in the pathological evaluation of surgically or endoscopically resected GIST, and does not always indicate incomplete resection. Although a GIST may have a tumor-positive pathologic margin, complete resection may be achieved if no residual tumor is visible, and long-term survival can be predicted as in the cases with a negative pathologic margin.

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Magnifying endoscopy with narrow-band imaging (M-NBI) can visualize superficial microanatomies in the stomach. The normal morphology of the microanatomy visualized by M-NBI differs according to the part of the stomach. The gastric fundic glandular mucosa appears as a regular honeycomb-like subepithelial capillary network (SECN) pattern with a regular collecting venule pattern and regular oval crypt opening with circular marginal crypt epithelium (MCE) pattern. The gastric pyloric glandular mucosa displays a regular coil-shaped SECN pattern and regular polygonal or curved MCE pattern. For a diagnosis of early gastric cancer using M-NBI, the vessel plus surface classification system was developed. This system is clinically useful for the differential diagnosis of focal gastritis and small depressed cancer and for determining the horizontal extent of early gastric cancer for successful endoscopic resection. Advantages of M-NBI over conventional endoscopic imaging techniques with white light include accurate diagnosis and cost effectiveness. This technique is a breakthrough in the endoscopic diagnostic field.

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Advanced imaging and therapeutic endoscopy
Chaitanya Pant, Mojtaba S. Olyaee, Amit Rastogi
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An update on gastric cancer
Syed A. Ahmad, Brent T. Xia, Christina E. Bailey, Daniel E. Abbott, Beth A. Helmink, Meghan C. Daly, Ramya Thota, Cameron Schlegal, Leah K. Winer, S. Ameen Ahmad, Ali H. Al Humaidi, Alexander A Parikh
Current Problems in Surgery.2016; 53(10): 449. CrossRef

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Original Article

Usefulness of Ready-to-Use 0.4% Sodium Hyaluronate (Endo-Ease) in the Endoscopic Resection of Gastrointestinal Neoplasms: Eun Ran Kim, Yun Gyoung Park, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim, Jung Ho Park, Dong Il Park, Dong Kyung Chang; Clin Endosc 2015;48(5):392-398. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.392

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Background/Aims

Commercially available sodium hyaluronate solutions are usually too thick to inject through catheters and need dilution with normal saline (NS) before use, which increases the risk of contamination. We evaluated the usefulness of ready-to-use 0.4% sodium hyaluronate, Endo-Ease (EE; UNIMED Pharm. Inc., Seoul, Korea).

Methods

We performed a prospective multicenter randomized study from May 2011 to September 2012. Patients requiring endoscopic resection (ER) for gastric or colorectal neoplasm at two referral hospitals were enrolled.

Results

One hundred fifty-four patients (72 with a gastric neoplasm and 82 with a colorectal neoplasm) were included in intention-to-treat analysis. Thirty-seven gastric neoplasms and 43 colorectal neoplasms were enrolled in the EE group. The usefulness rate was significantly higher in the EE group than in the NS group (89.2% vs. 60.0% for gastric neoplasms and 95.3% vs. 67.7% for colorectal neoplasms, p<0.001). In the EE group, the ease of mucosal resection was significantly higher than in the NS group (p<0.001). The injected volume was smaller in the EE group than in the NS group (p<0.05).

Conclusions

The use of EE reduced the need for additional injections and improved the ease of ER. A submucosal injection of EE is useful for the ER of both gastric and colorectal neoplasms.

Citations

Citations to this article as recorded by

Efficacy and safety of a submucosal injection solution of sodium alginate for endoscopic resection in a porcine model
Kyung Uk Jung, Yeon Jae Lee, Jae-Young Jang, Joo Young Cho
Scientific Reports.2024;[Epub] CrossRef
Injectable temperature-sensitive hydrogel facilitating endoscopic submucosal dissection
Ruifen Xu, Xiaoyu Yang, Tong Yi, Tao Tan, Zhongqi Li, Xuyang Feng, Jing Rao, Pinghong Zhou, Hao Hu, Yonghua Zhan
Frontiers in Bioengineering and Biotechnology.2024;[Epub] CrossRef
Hypertonic solution as an optimal submucosal injection solution for endoscopic resection of gastrointestinal mucosal lesions: Systematic review and network meta‐analysis
Li Gao, Jiawei Bai, Kai Liu, Lulu Wang, Shaohua Zhu, Xin Zhao, Ying Han, Zhiguo Liu
Digestive Endoscopy.2023;[Epub] CrossRef
Injectable Thermosensitive Chitosan Solution with β-Glycerophosphate as an Optimal Submucosal Fluid Cushion for Endoscopic Submucosal Dissection
Seung Jeong, Han Jo Jeon, Kyoung-Je Jang, Sangbae Park, Hyuk Soon Choi, Jong Hoon Chung
Polymers.2021; 13(11): 1696. CrossRef

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Focused Review Series: Advanced Endoscopic Treatment for Pancreaticobiliary Diseases

Recent Advances in Endoscopic Papillectomy for Ampulla of Vater Tumors: Endoscopic Ultrasonography, Intraductal Ultrasonography, and Pancreatic Stent Placement: Jimin Han, Dong Wook Lee, Ho Gak Kim; Clin Endosc 2015;48(1):24-30. Published online January 31, 2015; DOI: https://doi.org/10.5946/ce.2015.48.1.24

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Since it was first described nearly three decades ago, endoscopic papillectomy (EP) has been utilized as a less invasive, alternative therapy for adenoma of the major duodenal papilla. In this article, we review the recent advances in EP, especially those pertaining to endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS), and pancreatic stent placement for the prevention of postpapillectomy pancreatitis. Because EUS and IDUS have similar diagnostic accuracies, either modality can be used for the preprocedural evaluation of ampullary tumors. Nevertheless, further technical refinements are required for a more precise evaluation. Given the paucity of data on the usefulness of EUS and/or IDUS during follow-up after EP, a well-designed study is warranted. Furthermore, pancreatic stent placement appears to have a protective effect against postpapillectomy pancreatitis; however, a prospective, randomized, controlled study with a larger number of patients is needed to assess this finding. Moreover, since pancreatic stent placement after EP is not always successful, various novel techniques have been developed to ensure reliable stent placement. Despite the recent advances in EP, further technical refinements and studies are needed to confirm their efficacy.

Citations

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Se Woo Park, Tae Jun Song, Jin Seok Park, Jae Hyuk Jun, Tae Young Park, Dong Wook Oh, Sang Soo Lee, Myung-Hwan Kim
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Kyong Joo Lee, Tae Hoon Lee, Jae Hee Cho, Jong Jin Hyun, Sung Ill Jang, Seok Jeong, Jin‐Seok Park, Jae Kook Yang, Don Haeng Lee, Dong Ki Lee, Sang Heum Park
Journal of Gastroenterology and Hepatology.2022; 37(11): 2138. CrossRef

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Case Report

Gastric Squamous Papilloma in a 52-Year-Old Female Patient: Hyung Ha Jang, Hyung Wook Kim, Su Jin Kim, Choel Woong Choi, Su Bum Park, Byeong Jun Song, Dong Hoon Shin, Dae Hwan Kang; Clin Endosc 2014;47(6):571-574. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.571

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A papilloma is a benign epithelial lesion characterized by finger-like projections of tissue lined by an overgrowth of squamous cells and a core of connective tissue. We report a case of squamous papilloma on the cardia in a 52-year-old asymptomatic female. Endoscopy showed a 1-cm sized is polyp with hyperemic change originating from the cardia adjacent to the esophagogastric junction, the biopsy of which suggested a diagnosis of squamous papilloma. Endoscopic mucosal resection was performed to obtain a definite diagnosis and the polyp was completely removed. The histological result was compatible with squamous papilloma, and its surrounding tissues showed foveolar epithelium, which suggested a stomach origin. This is the first report of endoscopic resection of a gastric squamous papilloma. Squamous papilloma should be considered in the differential diagnosis of a gastric polyp, especially one in the cardia. As the prognostic value of a squamous papilloma is not well known, we recommend endoscopic resection to treat a gastric squamous papilloma, when possible.

Citations

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Overexpression of Neutrophil MMP-9 and HIF-1α May Contribute to the Finger-Like Projections Formation and Histo-Pathogenesis in Nasal Inverted Papilloma
Tao Li, Kai Sen Tan, Yan Yi Tu, Li Zhao, Jing Liu, Hsiao Hui Ong, De Yun Wang, Li Shi
Journal of Inflammation Research.2021; Volume 14: 2979. CrossRef

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Review

Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View: Jin Woong Cho, Suck Chei Choi, Jae Young Jang, Sung Kwan Shin, Kee Don Choi, Jun Haeng Lee, Sang Gyun Kim, Jae Kyu Sung, Seong Woo Jeon, Il Ju Choi, Gwang Ha Kim, Sam Ryong Jee, Wan Sik Lee, Hwoon-Yong Jung, Korean ESD Study Group; Clin Endosc 2014;47(6):523-529. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.523

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One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred.

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Special Issue Article of IDEN 2013

Tissue Acquisition in Gastric Epithelial Tumor Prior to Endoscopic Resection: Chan Gyoo Kim; Clin Endosc 2013;46(5):436-440. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.436

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Endoscopic forceps biopsy is essential before planning an endoscopic resection of upper gastrointestinal epithelial tumors. However, forceps biopsy is limited by its superficiality and frequency of sampling errors. Histologic discrepancies between endoscopic forceps biopsies and resected specimens are frequent. Factors associated with such histologic discrepancies are tumor size, macroscopic type, surface color, and the type of medical facility. Precise targeting of biopsies is recommended to achieve an accurate diagnosis, curative endoscopic resection, and a satisfactory oncologic outcome. Multiple deep forceps biopsies can induce mucosal ulceration in early gastric cancer. Endoscopic resection for early gastric cancer with ulcerative findings is associated with piecemeal resection, incomplete resection, and a risk for procedure-related complications such as bleeding and perforation. Such active ulcers caused by forceps biopsy and following submucosal fibrosis might also be mistaken as an indication for more aggressive procedures, such as gastrectomy with D2 lymph node dissection. Proton pump inhibitors might be prescribed to facilitate the healing of biopsy-induced ulcers if an active ulcer is predicted after deep biopsy. It is unknown which time interval from biopsy to endoscopic resection is appropriate for a safe procedure and a good oncologic outcome. Further investigations are needed to conclude the appropriate time interval.

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The Clinical Significance and Management of Noncurative Endoscopic Resection in Early Gastric Cancer: Jun Heo, Seong Woo Jeon; Clin Endosc 2013;46(3):235-238. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.235

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Nowadays, endoscopic mucosal resection or endoscopic submucosal dissection has shown effectiveness equivalent to that of gastrectomy and has emerged as a popular technique for curative treatment of gastric cancer. However, noncurative resection or resection beyond the indication may lead to lymphatic and extended organ metastasis resulting in loss of the opportunity for full recovery. Therefore, it is an important issue to decide the range of curative resection in the endoscopic resection field. Furthermore, management of noncurative endoscopic resection in early gastric cancer is also important. The most favorable treatment after noncurative resection would be surgery. However, other noninvasive treatments such as argon plasma coagulation, additional endoscopic resection and close observation for recurrence are thought to be the optional treatments after the noncurative resection. In the future, prospective research studies and observations are expected to verify the effectiveness of noninvasive treatments.

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