title: Safety and feasibility of simultaneous endoscopic submucosal dissection for multiple gastric neoplasias.
abstract: BACKGROUND
  Synchronous gastric neoplasms are not infrequently detected, thus endoscopic submucosal dissection (ESD) for multiple early gastric neoplasia is occasionally considered. However, there have been few investigations of the safety and feasibility of simultaneous ESD for multiple gastric lesions. This study aims to evaluate the safety and feasibility of simultaneous ESD for multiple gastric neoplasia.
  
  
  METHODS
  A total of 1823 patients who underwent ESD for 1929 gastric adenomas or early gastric cancers were retrospectively reviewed in this study. Two hundred gastric adenomas or early gastric cancers among 94 patients were treated by ESD simultaneously (multiple group), and 1729 patients were treated with ESD for a single lesion (single group).
  
  
  RESULTS
  En bloc resection (P = 0.060), complete resection (P = 0.362) and curative resection (P = 0.108) rates did not differ between the two groups. Rates of adverse events including bleeding (P = 0.317), perforation (P = 0.316) and aspiration pneumonia (P = 0.563) were not higher in the multiple group. Long-term follow-up showed more frequent local recurrence (P < 0.001), synchronous neoplasia (P = 0.041) and metachronous neoplasia (P < 0.001) per patient in the multiple group; however, local recurrence per lesion did not differ between the two groups (P = 0.103).
  
  
  CONCLUSIONS
  Simultaneous ESD for multiple synchronous gastric neoplasms is safe and feasible compared to single ESD. However, thorough examination for local recurrence and synchronous and metachronous neoplasia is required.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea. donje999@gmail.com.
authors.forename: Dong Hoo
authors.initials: DH
authors.lastname: Joh
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Chan Hyuk
authors.initials: CH
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Sungmo
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Ki
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Jun Chul
authors.initials: JC
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Sung Kwan
authors.initials: SK
authors.lastname: Shin
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Republic of Korea. sklee@yuhs.ac.
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D004210:Dissection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D012189:Retrospective Studies; D012449:Safety; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome
keywords: Endoscopic submucosal dissection; Multiple gastric neoplasms; Outcomes