How can we predict the presence of missed synchronous lesions after endoscopic submucosal dissection for early gastric cancers or gastric adenomas?
OBJECTIVE
To identify predictive factors associated with the presence of missed synchronous lesions after endoscopic submucosal dissection (ESD) for gastric adenoma or early gastric cancer (EGC).


BACKGROUND
Secondary gastric neoplasms that develop during follow-up period after ESD for gastric adenoma or EGC are divided into metachronous lesions and missed synchronous lesions.


METHODS
ESD was performed in 250 patients with EGC or gastric adenoma. The patients with endoscopic follow-ups of <1 year, patients without curative resection, and patients with additional surgery were excluded from the study. Missed synchronous lesions were defined as secondary gastric neoplasms detected within one year of ESD but initially missed. We compared clinicopathologic factors between patients with missed synchronous lesions and patients without missed synchronous lesions.


RESULTS
Missed synchronous lesions were found in 11.6% of the patients (29/250). The occurrence of missed synchronous lesions had significant correlation with tumor number at the time of ESD and age in the univariate analysis. Tumor number at the time of ESD and age were significant independent predictive factors for presence of missed synchronous lesions by multivariate logistic regression analysis (odds ratio 5.302, P = 0.006; odds ratio 2.315, P = 0.040, respectively). Missed synchronous lesions tended to be smaller, often located in the same third of the stomach as the main lesions.


CONCLUSIONS
Tumor number at the time of ESD and age could be predictive factors for the presence of missed synchronous lesions after ESD. Careful endoscopic surveillance should be performed after ESD for multiple lesions or for elderly patients.
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Jun Hwan
JH
Yoo
Sung Jae
SJ
Shin
Kee Myung
KM
Lee
Jae Myoung
JM
Choi
Jeong Ook
JO
Wi
Dong Hoon
DH
Kim
Sun Gyo
SG
Lim
Jae Chul
JC
Hwang
Jae Youn
JY
Cheong
Byung Moo
BM
Yoo
Kwang Jae
KJ
Lee
Jin Hong
JH
Kim
Sung Won
SW
Cho
D000236:Adenoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D003951:Diagnostic Errors; D055088:Early Detection of Cancer; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome