Risk of metachronous gastric neoplasm occurrence during intermediate-term follow-up period after endoscopic submucosal dissection for gastric dysplasia

Abstract

After endoscopic resection (ER) of gastric dysplasia, metachronous gastric neoplasm (MGN) appears to have an incidence rate similar to that detected after ER of early gastric cancer (EGC). We investigated whether the risk of MGN after ER for gastric dysplasia is different between patients with low-grade dysplasia (LGD) and high-grade dysplasia (HGD). Between March 2011 and December 2016, 198 patients with LGD (LGD group) and 46 patients with HGD (HGD group) who underwent ER were included in the study. During a median follow-up of 2.5 years, MGNs developed in 21 patients (10.6%) in the LGD group and in 6 patients (13.0%) in the HGD group. Hazard ratios (HRs) for MGNs (HR, 1.45; P = 0.425) and for metachronous HGD or gastric cancer (HR, 2.41; P = 0.214) in the HGD group were not different than those of the LGD group. However, considering patients without Helicobacter pylori infection, those in the HGD group had a significantly increased risk of metachronous HGD or gastric cancer compared to those in the LGD group (HR in HGD-group, 5.23; P = 0.044). These results indicate that meticulous surveillance endoscopy is needed to detect MGNs after ER of gastric dysplasia, especially in patients with HGD, including those without H. pylori infection.Patients. We retrospectively collected clinical and pathological data of consecutive patients who underwent endoscopic submucosal dissection (ESD) for gastric neoplasms at the Chung-Ang University Hospital between March 2011 and December 2016. The inclusion criteria were as follows: patients diagnosed with gastric dysplasia (LGD or HGD) on final pathological evaluations after ESD and patients with follow-up periods of more than 1 year. Patients were excluded if follow-up periods after ESD were less than 1 year, or if ESD was performed for EGC. This study was approved by the Institutional Review Board of Chung-Ang University Hospital (IRB number: 1801-002-16134). The requirement for informed consent from all included patients was waived by the Institutional Review Board due to the minimal risk of the study. The study was conducted in accordance with the Helsinki Declaration.The patients' clinical data that was analyzed included the following: baseline demographics, co-morbid diseases, and Helicobacter pylori infection status. Pathological data included the following: the presence of multiple initial lesions, tumor location, size, and histological grade of dysplasia.ESD procedures and follow-up schedule. Detailed ESD procedures were described in a previous study 17 .All ESD procedures were performed by experienced gastroenterologists who were certified specialty board members of the Korean Society of Gastrointestinal Endoscopy. After indigocarmine was applied to the dysplastic lesion, we made markings around the margin of lesion using electrocautery or argon plasma coagulation. A mixture of hyaluronic acid and/or normal saline, 0.2% indigocarmine, and 1:10,000 epinephrine solution was injected into the submucosa. Circumferential pre-cutting and submucosal dissection were performed ...

The Incidence and Risk Factors for Metachronous Gastric Cancer in the Remnant Stomach after Gastric Cancer Surgery

“…In another similar study regarding risk of MGN occurrence after endoscopic submucosal dissection for gastric dysplasia showed that MGNs developed in 21 patients (10.6%) in the low-grade dysplasia group and in six patients (13.0%) in the high-grade dysplasia group. 37 In the present study the overall incidence of metachronous GC was 1.1%, which is lower rate of MGN after endoscopic treatment. It could be a meaningful result that a higher incidence rate of metachronous GC was observed in patients with PG or PPG compared to patients with DG.…”

“…Referring to other studies reported in Korea, the number of metachronous adenomas and cancers after DG was 18 and 12 (however, in this study, the incidence of metachronous neoplasms could not be identified since only cases treated with endoscopic submucosal dissection were collected). 45 And Kim et al 37 reported that the incidence of metachronous neoplasms after endoscopic treatment for gastric dysplasia was 11.0%, and the number of metachronous adenomas and cancers was 24 (18 low-grade adenomas and six high-grade adenomas) and three, respectively. Although the number of MGNs in patients received surgery might be smaller due to the decreased area of the remnant stomach after surgery, the ratio of adenoma and cancer could be similar.…”

Management of patients with multiple primary сancer in the practice of a modern oncologist. Case report and literature review

“…Рак желудка (РЖ) является одной из самых значимых проблем современной онкологии. Занимая 3-е место в статистике смертности от рака во всем мире [35], данная патология ставит перед онкологами задачу совершенствования скрининга и методов диагностики. Эзофагогастродуоденоскопия (ЭГДС), вошедшая в скрининговую программу рака желудка в Японии, несомненно, привела к улучшению его выявляемости на ранних стадиях.…”

Endoscopic diagnosis and treatment of gastric dysplasia and early cancer: Current evidence and what the future may hold

“…Sumiyoshi et al [ 160 ] analysed predisposing factors, with the only risk factor after multivariate analysis being a > 75% circumferential post-resection defect[ 160 ]. In regard to treatment, while data is limited, most patients have improvement in their symptoms following either balloon dilation if severe, or conservative management if mild-moderate symptoms[ 162 , 163 ].…”