Clinical Endoscopy

Original Article

Endoscopic Submucosal Dissection for Early Gastric Neoplasia Occurring in the Remnant Stomach after Distal Gastrectomy: Ji Young Lee, Byung-Hoon Min, Jung Gyu Lee, Donghyo Noh, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim; Clin Endosc 2016;49(2):182-186. Published online February 11, 2016; DOI: https://doi.org/10.5946/ce.2015.049

Background
/Aims: Endoscopic submucosal dissection (ESD) for tumors occurring in the remnant stomach is technically difficult to perform because of limited working space and severe fibrosis and staples present around the suture line. We aimed to elucidate the feasibility and clinical outcomes of performing ESD for tumors in the remnant stomach.
Methods
Between December 2007 and January 2013, 18 patients underwent ESD for tumors (six adenomas and 12 differentiated-type early gastric cancers [EGCs]) occurring in the remnant stomach after distal gastrectomy. Clinicopathologic features and clinical outcomes after ESD were retrospectively analyzed.
Results
Two-thirds of the lesions were located on the body, and half were located on the suture line. En bloc resection, R0 resection, and en bloc with R0 resection rates were 88.9%, 100%, and 88.9%, respectively. Curative resection rate for EGC was 91.7%. Perforation occurred in one patient (5.6%) and was successfully managed by endoscopic closure with metallic clips and conservative management. There was no significant bleeding after ESD. During a median follow-up of 47.5 months, no local, metachronous, or extragastric recurrence was seen for either EGC or adenoma lesions.
Conclusions
ESD is a feasible and effective treatment modality and can be considered a primary intervention for early gastric neoplasia occurring in the remnant stomach.

Citations

Citations to this article as recorded by

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Katrin Sommer, Maximilian Wiendl, Tanja M. Müller, Karin Heidbreder, Caroline Voskens, Markus F. Neurath, Sebastian Zundler
Frontiers in Medicine.2021;[Epub] CrossRef
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Su Jin Kim, Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Hyeong Seok Nam, Dae Gon Ryu
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Endoscopic submucosal dissection for early neoplastic lesions in the surgically altered stomach: a systematic review and meta-analysis
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증례 : 식도 위장관 ; 위하수증으로 위 부분절제술 후 발생한 조기 잔위암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; One Case of Early Gastric Stump Cancer Following Partial Gastrectomy for Gastroptosis ): Korean J Gastrointest Endosc 1997;17(2):173-179. Published online November 30, 1996

Abstract PDF: Gastric stump cancer is defined as cancers that develop in the gastric remnant after the gastric resection of nonmalignant lesions or malignant lesions. The interval between gastrectomy and the detection of gastric stump cancer must be over 5 years in nonmaligant lesions and 10 years in malignant lesions. Symptoms of gastric stump cancer are not specific, so, diagnosis is often delayed. Early detection and curative operation is very important in gasric stump cancer and follow-up endoscopic examination is the most importaint diagnostic tool to detect gastric stump cancer. Recently we experienced a case of early gastric stump cancer. We report review of the literature to remind the important of gastric stump cancer and the important of follow-up endoscopic examination. (Korean J Gastrointest Endosc 17: 173-177, 1997)

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십이지장궤양으로 위공장물합술후 (胃空腸物合術) 발생한 조기위암 1예 ( Early Cancer of the Gastric Stump after Gastrojejunostomy for Duodenal Ulcer Obstruction ): Korean J Gastrointest Endosc 1990;10(2):331-335. Published online November 30, 1989

Abstract PDF: Cancer of the gastric stump, first described by Balfour in 1922, is defined as the cancer detected more than 5 years after surgery for a benign disease. We experienced a case of cancer found at the gastric stump after gastrojejunostomy in a 53 years old male patients, proven pathologically as a early cancer. He visited to our hospital with the chief complaint of epigastric pain and indigestion for 1 Months. On past history, he has been received gastrojejunostomy due to duodenal ulcer obstruction, 23 years ago, Gastrofiberscopy was done, and we could find the early gastric cancer lesions at the anterior wall of gastric angle as type Ilc+III and antrum as type IIa. The microscopic finding of the multiple endoscopic biopsies at the gastic angle and antrum revealed the adenocarcinoma of signet ring cell type infiltrated to the level of submucosa. And so, we could diagnose these lesions as a early gastric cancer in the gastric stump after gastrojejunostomy. He was treated with subtotal gastrectomy and discharged with cured condition. Therefore, we report this case with a literature review.

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