title: Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD.
  
  
  METHODS
  In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study.
  
  
  RESULTS
  In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%.
  
  
  CONCLUSIONS
  We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea.
authors.forename: Mi Young
authors.initials: MY
authors.lastname: Jang
authors.forename: Jin Woong
authors.initials: JW
authors.lastname: Cho
authors.forename: Wang Guk
authors.initials: WG
authors.lastname: Oh
authors.forename: Sung Jun
authors.initials: SJ
authors.lastname: Ko
authors.forename: Shang Hoon
authors.initials: SH
authors.lastname: Han
authors.forename: Hoon Ki
authors.initials: HK
authors.lastname: Baek
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Lee
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Kim
authors.forename: Gum Mo
authors.initials: GM
authors.lastname: Jung
authors.forename: Yong Keun
authors.initials: YK
authors.lastname: Cho
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D004210:Dissection; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; 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
keywords: Neoplasms, multiple primary; Neoplasms, second primary; Stomach neoplasms