title: [Clinicopathologic features of cases with negative pathologic results after endoscopic submucosal dissection].
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is accepted as a standard treatment of early gastric cancer (EGC) and gastric adenoma. Occasionally, tumorous lesion is not found and pathologic discrepancies can occur after ESD. The aim of this study was to analyze the factors affecting the negative pathologic results after ESD.
  
  
  METHODS
  We retrospectively reviewed the data from all patients with gastric neoplasm (276 EGC and 516 gastric adenomas) who were treated with ESD during past 3 years and enrolled the patients who had negative pathologic results.
  
  
  RESULTS
  Out of 792 patients treated with ESD, 27 patients (3.4%) were eligible for inclusion. Among the 27 patients, factors affecting the negative pathologic results were, most commonly, the focal lesion (n=13, 48.2%) which was small enough to be removed completely during pre-ESD biopsy, followed by pathologic discrepancies (n=11, 40.7%) between pathologists and lastly the operator factor (n=3, 11.1%) dissecting incorrect lesions. Of the focal lesions, the initial pathologic diagnoses were adenocarcinoma in 11 cases (84.6%). In cases with pathologic discrepancies, all the pretreatment diagnoses were adenoma with low grade dysplasia. In cases caused by operator factors, intestinal metaplasia was accompanied by elevated adenoma in all cases.
  
  
  CONCLUSIONS
  To decrease negative pathologic results after ESD, an endoscopist should perform ESD after sufficient communication with pathologists, especially for adenoma with low grade dysplasia, and choose correct lesion, especially located at the antrum and associated with intestinal metaplasia. The possibility of total removal of small lesions even by forcep biopsy should be considered.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea.
authors.forename: Min-Jung
authors.initials: MJ
authors.lastname: Kwon
authors.forename: Jong-Jae
authors.initials: JJ
authors.lastname: Park
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Yun
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Noh
authors.forename: Dae Woong
authors.initials: DW
authors.lastname: Yoon
authors.forename: Won Jin
authors.initials: WJ
authors.lastname: Chang
authors.forename: Ha Young
authors.initials: HY
authors.lastname: Oh
authors.forename: Baek-Hui
authors.initials: BH
authors.lastname: Kim
authors.forename: Hyunjoo
authors.initials: H
authors.lastname: Lee
authors.forename: Moon Kyung
authors.initials: MK
authors.lastname: Joo
authors.forename: Beom Jae
authors.initials: BJ
authors.lastname: Lee
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Jae Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Bak
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D000368:Aged; D004210:Dissection; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery