Causes of missed synchronous gastric epithelial neoplasms with endoscopic submucosal dissection: a multicenter study.
OBJECTIVE
Unlike surgery, endoscopic submucosal dissection (ESD) removes gastric epithelial neoplasms within a tight margin, leaving most normal tissue around the neoplasm intact, thus resulting in a high risk for missed synchronous gastric epithelial neoplasms (mSGENs). The purpose of this study was to evaluate the characteristics and risk factors of mSGENs (mSGENs) compared to simultaneously identified SGENs (siSGENs) in patients who underwent ESD.


METHODS
The authors have retrospectively examined 312 SGENs from 275 patients treated with ESD at three hospitals in Korea between January 2004 and May 2011. The incidence and clinicopathological features of SGENs, mSGENs, and siSGENs were investigated. Any second epithelial neoplasm found within 1 year of the first ESD procedure was defined as an mSGEN and any neoplasm detected simultaneously with the first neoplasm was defined as a siSGEN.


RESULTS
The overall incidence of ESD patients with SGENs was 9.1% (275 of 3018 patients). Of the SGENs, 45.2% were siSGENs and 54.8% were mSGENs. Independent risk factors for mSGENs were adenoma as the first gastric lesion (Exp (B) = 2.154, 95% CI: 1.282-3.262) and duration of endoscopic examination before the first ESD (Exp (B) = 1.074, 95% CI: 1.001-1.141). The results suggest that 33% of mSGENs could have been identified during the endoscopic examination prior to ESD.


CONCLUSIONS
Additional effort needs to be expended in identifying siSGENs, particularly prior to ESD for less serious adenomas. This should include sufficient time for endoscopic examination, prior to ESD, to ensure a thorough examination for siSGENs.
Department of Internal Medicine, The Catholic University of Korea College of Medicine , Seoul , Korea.
Hyung Hun
HH
Kim
Ji Hyun
JH
Kim
Gwang Ha
GH
Kim
Myung-Gyu
MG
Choi
Sam Ryong
SR
Jee
Geun Am
GA
Song
D000368:Aged; D003951:Diagnostic Errors; D004210:Dissection; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000601:surgery*; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome