CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(10): E1198-E1203
DOI: 10.1055/a-0607-2452
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Polypoid nodule scar after gastric endoscopic submucosal dissection: results from a multicenter study

Vitor Arantes
1  Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Hospital Mater Dei Contorno, Belo Horizonte, Brazil
,
Noriya Uedo
2  Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
,
Yoshinori Morita
3  Department of Gastroenterology, Kobe University School of Medicine, Kobe, Japan
,
Takashi Toyonaga
4  Department of Endoscopy, Kobe University School of Medicine, Kobe, Japan
,
Yoshiko Nakano
3  Department of Gastroenterology, Kobe University School of Medicine, Kobe, Japan
,
Moises Salgado Pedrosa
5  Pathology Department, School of Medicine, Federal University of Minas Gerais, Laboratory CEAP, Belo Horizonte, Brazil
,
Ichiro Oda
6  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Yutaka Saito
6  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Haruhisa Suzuki
6  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Katsumi Yamamoto
7  Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital. Osaka, Japan
,
Yu Sato
7  Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital. Osaka, Japan
,
Peter V. Draganov
8  University of Florida, Gainesville, Florida, United States
› Author Affiliations
Further Information

Publication History

submitted 01 February 2018

accepted after revision 15 March 2018

Publication Date:
08 October 2018 (online)

Abstract

Background and study aims A post-endoscopic submucosal dissection (ESD) scar is expected to look homogeneous, however, some patients develop benign polypoid nodule scar (PNS). Incidence of PNS is unknown, yet these scars have direct clinical implications because they may render evaluation of post-ESD neoplastic recurrence difficult. Therefore, we reviewed the clinical experience of 5 ESD referral centers and evaluated their PNS incidence and clinical management.

Patients and methods This was a retrospective multicenter case series enrolling patients that underwent R0, curative gastric ESD from 2003 to 2015 in 5 academic centers. PNS was defined as ESD site nodularity with hyperplastic or regenerative tissue histology.

Results A total of 2275 patients underwent gastric ESD with endoscopy control and 28 patients (18 men/10 women) developed PNS for overall incidence of 1.2 %. Incidence of PNS ranged from 0.15 % to 11.4 % between centers. All patients that developed PNS had primary neoplastic lesions located in the distal stomach. Considering only lesions situated in the antrum (n = 912), incidence of PNS was 3.1 %. After mean follow-up of 43 months (range 6 – 192), no malignant recurrence in the PNS has been identified. In five patients (17.8 %) PNS disappeared after a mean of 18 months.

Conclusion PNS occurs exclusively after ESD in the distal stomach in approximately 3.1 % of patients. Although PNS appearance can be concerning, no malignant recurrence was observed after curative R0 resection. Therefore, PNS should be viewed as a benign alteration that does not require any type of intervention, other than endoscopic surveillance.