Endoscopy 2019; 51(04): S105
DOI: 10.1055/s-0039-1681480
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 11:00 – 13:00: ESD stomach 2 Club A
Georg Thieme Verlag KG Stuttgart · New York

CLINICAL OUTCOMES AND POST-PROCEDURAL COMPLICATIONS OF ENDOSCOPIC SUBMUCOSAL DISSECTION OF GASTRIC NEOPLASIA INVOLVING THE PYLORIC CHANNEL

JS Koh
1   Gastroenterology, Korea University Guro Hospital, Seoul, Korea, Republic of
,
JJ Park
1   Gastroenterology, Korea University Guro Hospital, Seoul, Korea, Republic of
,
MK Joo
1   Gastroenterology, Korea University Guro Hospital, Seoul, Korea, Republic of
,
BJ Lee
1   Gastroenterology, Korea University Guro Hospital, Seoul, Korea, Republic of
,
HJ Chun
2   Gastroenterology, Korea University Anam Hospital, Seoul, Korea, Republic of
,
SW Lee
3   Gastroenterology, Korea University Ansan Hospitals, Ansan, Korea, Republic of
,
CH Yang
4   Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea, Republic of
,
EY Kim
5   Catholic University of Daegu School of Medicine, Daegu, Korea, Republic of
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Gastric neoplasia involving pyloric channel (GNPC) is technically difficult and post-procedural stenosis is concerned. We evaluated the feasibility and effectiveness of the endoscopic submucosal dissection (ESD) for GNPC, and predictive factors for stenosis during follow-up.

Methods:

Ninety-seven patients with GNPC underwent ESD from January 2007 to October 2017. We retrospectively analyzed the short-term clinical outcomes and post-procedural stenosis.

Results:

Among 97 patients, male were 59 (60.8%), and mean age was 63.1 years.

Fifty-eight cases (59.8%) were tubular adenoma (42 low grade dysplasia, 16 high grade dysplasia) and 34 (35.1%) were early gastric cancer. In 46 cases (47.4%), conventional anterograde ESD without retroflexion in the duodenum was performed, and 51 cases (52.6%) were resected by the retroflexion method. Seventy-seven lesions (79.4%) were located at pyloric channel and either antral or bulb side, and 20 cases (20.6%) were located throughout antrum and bulb. En bloc resection rate and R0 resection rate were 87.6% (85/97) respectively. Post-procedural stenosis was observed in 16 cases (16.5%). By multivariate analysis, resected circumference of pyloric channel ≥75% was the only predictive factor for stenosis (odds ratio; 8.15, 95% confidence interval; 1.97 – 33.74, p = 0.004). However, all the stenosis was managed with conservative method such as balloon dilatation. Compared with anterograde resection, retroflexion method was performed in tumors located throughout antrum and bulb (17/51, 33.3% vs. 9/46, 6.5%, p = 0.001), and larger tumors (17.1 mm vs. 11.8 mm, p = 0.004).

Conclusions:

ESD is a feasible method for treatment of GNPC. Retroflexion method may be effective for larger tumor located throughout antrum and bulb. However, if resected circumference of pyloric channel is over 75%, post-procedural stenosis is expected.