title: Endoscopic submucosal dissection for early gastric cancer in anastomosis site after distal gastrectomy.
abstract: BACKGROUND
  Detection of early gastric cancer (EGC) in the remnant stomach is increasing because of follow-up endoscopic surveillance programs. Endoscopic treatment appears to be desirable for EGC in the remnant stomach because it is less invasive than surgical resection.
  
  
  METHODS
  In this retrospective study, to evaluate the feasibility of endoscopic submucosal dissection (ESD) for EGC in an anastomotic site, treatment results of ESD for EGC in an anastomotic site and in remnant stomach not involving an anastomotic site were compared. In total, 11 EGC lesions of anastomotic sites in 11 patients and 22 EGC lesions of remnant stomach not involving an anastomotic site in 21 patients were treated by ESD.
  
  
  RESULTS
  All lesions were successfully treated by en bloc resection. There were three patients with perforations in the anastomotic site group. Although resected specimen size and tumor size were larger in the anastomotic site group than in the non-anastomotic site group (P < 0.01), the procedure duration was far longer in the anastomotic site group than in the non-anastomotic site group (P < 0.01). The speed of the procedure was faster in the non-anastomotic site group than in the anastomotic site group (P < 0.05).
  
  
  CONCLUSIONS
  Although ESD for EGC in an anastomotic site is a time-consuming procedure and requires advanced techniques compared with ESD for EGC not involving an anastomotic site, a high en bloc resection rate was achieved. ESD by endoscopists with sufficient experience appears to be a feasible treatment for EGC in an anastomotic site.
authors.affiliation: Department of Endoscopy, Kobe University, 7-5-1 Chu-o-ku, Kusunoki-Cho, Kobe, Hyogo, 650-0017, Japan, tanakas@med.kobe-u.ac.jp.
authors.forename: Shinwa
authors.initials: S
authors.lastname: Tanaka
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Fujita
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yoshizaki
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Kawara
authors.forename: Chika
authors.initials: C
authors.lastname: Wakahara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Obata
authors.forename: Aya
authors.initials: A
authors.lastname: Sakai
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ishida
authors.forename: Nobunao
authors.initials: N
authors.lastname: Ikehara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D004724:Endoscopy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D018530:Gastric Stump / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*