Endoscopic submucosal dissection for gastric tumors in various types
                    of remnant stomach

Toshiyasu Ojima; Katsunari Takifuji; Masaki Nakamura; Mikihito Nakamori; Masahiro Katsuda; Takeshi Iida; Keiji Hayata; Makoto Iwahashi; Hiroki Yamaue

doi:10.1055/s-0034-1365454

Endoscopy, Table of Contents

Endoscopy 2014; 46(08): 645-649
DOI: 10.1055/s-0034-1365454

Original article

Endoscopic submucosal dissection for gastric tumors in various types of remnant stomach

Toshiyasu Ojima

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

,

Katsunari Takifuji

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

,

Masaki Nakamura

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

,

Mikihito Nakamori

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

,

Masahiro Katsuda

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

,

Takeshi Iida

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

,

Keiji Hayata

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

,

Makoto Iwahashi

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

,

Hiroki Yamaue

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

› Author Affiliations

Abstract

Background and study aims: The aim of this study was to examine the clinical outcomes of endoscopic submucosal dissection (ESD) for gastric tumors in various types of remnant stomach.

Patients and methods: Between January 2002 and March 2013, ESD was performed for 750 gastric tumors. Of these lesions, 49 were in a remnant stomach, and were included in the study.

Results: The en bloc resection rate was 100 %. The curative resection rate was 82 %. The rate of perforation was high in patients with gastric conduits (28.6 %). Perforation was significantly more common in patients with lesions located on the suture line (4.9 % vs. 50.0 %; P = 0.0043).

Conclusion: ESD for gastric tumors in the remnant stomach can be considered feasible and safe in clinical practice. However, the procedure is technically more difficult in patients with a gastric conduit, due to the increased risk of perforation at the suture line.

Full Text

References

References
1 Ojima T, Takifuji K, Nakamura M et al. Complications of endoscopic submucosal dissection for gastric noninvasive neoplasia: an analysis of 647 lesions. Surg Laparosc Endosc Percutan Tech In press 2014;
2 Ojima T, Iwahashi M, Nakamori M et al. Clinicopathological characteristics of remnant gastric cancer after a distal gastrectomy. J Gastrointest Surg 2010; 14: 277-281
3 Hoteya S, Iizuka T, Kikuchi D et al. Clinical advantages of endoscopic submucosal dissection for gastric cancers in remnant stomach surpass conventional endoscopic mucosal resection. Dig Endosc 2010; 22: 17-20
4 Hirasaki S, Kanzaki H, Matsubara M et al. Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife. World J Gastroenterol 2008; 14: 2550-2555
5 Takenaka R, Kawahara Y, Okada H et al. Endoscopic submucosal dissection for cancers of the remnant stomach after distal gastrectomy. Gastrointest Endosc 2008; 67: 359-363
6 Osumi W, Fujita Y, Hiramatsu M et al. Endoscopic submucosal dissection allows less-invasive curative resection for gastric tube cancer after esophagectomy – a case series. Endoscopy 2009; 41: 777-780
7 Lee JY, Choi IJ, Cho SJ et al. Endoscopic submucosal dissection for metachronous tumor in the remnant stomach after distal gastrectomy. Surg Endosc 2010; 24: 1360-1366
8 Nonaka S, Oda I, Makazu M et al. Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy. Gastrointest Endosc 2013; 78: 63-72
9 Nishide N, Ono H, Kakushima N et al. Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in remnant stomach or gastric tube. Endoscopy 2012; 44: 577-583
10 Soetikno R, Kaltenbach T, Yeh R et al. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 2005; 23: 4490-4498
11 Edge SB, Byrd DR, Compton CC et al. AJCC cancer staging manual. 7th edn. New York: Springer; 2009
12 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-213
13 Japanese Gastric Cancer Society Eds. Guidelines for diagnosis and treatment of carcinoma of the stomach. Tokyo: Kanehara Shuppan; 2010
14 Nonaka S, Saito Y, Takisawa H et al. Safety of carbon dioxide insufflation for upper gastrointestinal tract endoscopic treatment of patients under deep sedation. Surg Endosc 2010; 24: 1638-1645