Endoscopy 2019; 51(04): S41-S42
DOI: 10.1055/s-0039-1681292
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ESD stomach 1 Club A
Georg Thieme Verlag KG Stuttgart · New York

SHORT- AND LONG-TERM OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE REMNANT STOMACH

K Nomura
1   Toranomon Hospital, Tokyo, Japan
,
S Hoteya
1   Toranomon Hospital, Tokyo, Japan
,
D Kikuchi
1   Toranomon Hospital, Tokyo, Japan
,
T Iizuka
1   Toranomon Hospital, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

We evaluated the short- and long-term outcomes of endoscopic submucosal dissection (ESD) performed in the remnant stomach after gastrectomy or esophagectomy.

Methods:

We retrospectively analyzed 120 patients with 139 lesions who underwent ESD in the remnant stomach at our hospital between January 2005 and December 2017. Patient characteristics, tumor diameter, operation time, rate of general anesthesia, incidence of complications, rate of en bloc resection, rate of curative resection (CR), and long-term outcome were investigated.

Results:

Median follow-up period was 1773 (7 – 4637) days. Patient characteristics were a mean age of 71.6 (45 – 87) years, mean tumor diameter of 17.9 mm, mean operation time of 112.6 min, general anesthesia rate of 23.3%, incidence of perforation and postoperative hemorrhage of 2.5% and 5.0%, respectively, en bloc resection rate of 89.2%, and CR rate of 77.0%. Eighty-nine patients underwent CR and 31 patients underwent non-CR. Of the non-CR cases, 6 underwent total gastrectomy of the remnant stomach and none of them was found to have lymph node metastasis. The remaining 25 non-CR cases included 2 patients who underwent additional argon plasma coagulation and 23 patients placed under follow-up observation. The 5-year survival rate was 92.3% (95% confidence interval: 83.4 – 96.5) in the entire population, 93.3% (82.9 – 97.5) in the CR group, and 89.5% (63.6 – 97.3) in the non-CR group. No patient experienced metastasis or recurrence or died of gastric cancer. Death due to other causes was reported in 8 and 3 patients in the CR and non-CR groups, respectively (cancer in other organs in 5 and 2 patients, respectively).

Conclusions:

Despite its technical complexity, ESD in the remnant stomach provided good outcomes, with a 5-year survival of 92.3% (89.5% even in the non-CR group). However, other organs need to be carefully monitored as well because of the relatively frequent occurrence of metachronous cancer in other organs.