COMPARISON OF CLINICAL OUTCOME BETWEEN REMNANT AND ENTIRE STOMACH IN ENDOSCOPIC SUBMUCOSAL DISSECTION FOR LESIONS ON THE PROXIMAL STOMACH

Aims:

Tumors located on the proximal stomach are associated with the poor clinical outcome. Gastric endoscopic submucosal dissection (ESD) for lesions after distal gastrectomy is more difficult because of the narrow inner space. We aimed to compare the therapeutic outcomes of ESD for proximal gastric lesion between the remnant and entire stomach.

Methods:

A total of 135 patients with neoplasm located on the proximal stomach who received ESD from Aug 2008 to Dec 2016. We retrospectively reviewed en bloc resection rate, complete resection rate, and complication rate according to the status of stomach.

Results:

The rates of en bloc resection and complete resection were 93.3% (126/135) and 88.9% (120/135). There was no significant difference between the remnant stomach and entire stomach in the en bloc (92% [23/25] and 93.6% [103/110], p= 0.674) and complete resection (84% [21/25] and 90.0 [99/110], p= 0.478) rates. The incidence of procedure related adverse events were higher in the remnant stomach (8%, one perforation and one delayed bleeding) compared with entire stomach (1.8%, two cases of delayed bleeding) (p= 0.042). The tumor size and submucosa invasive cancer were associated with incomplete resection. In a multivariable analysis, the tumor size more than 1 cm was an independent risk factor for incomplete resection.

Conclusions:

ESD is feasible treatment for the lesion located on the proximal stomach regardless the operation history of distal gastrectomy. However, the complete resection rate decreases for lesion sized more than 1 cm.