Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

• Published in: The Korean journal of internal medicine Vol. 28; no. 6; pp. 687 - 693
• Main Authors: Jang, Mi Young, Cho, Jin Woong, Oh, Wang Guk, Ko, Sung Jun, Han, Shang Hoon, Baek, Hoon Ki, Lee, Young Jae, Kim, Ji Woong, Jung, Gum Mo, Cho, Yong Keun
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Association of Internal Medicine 01.11.2013; 대한내과학회
• Subjects: Adenoma - epidemiology; Adenoma - pathology; Adenoma - surgery; Age Factors; Aged; Dissection; Female; Gastrectomy - methods; Gastric Mucosa - pathology; Gastric Mucosa - surgery; Gastroscopy; Humans; Incidence; Male; Middle Aged; Neoplasms, Multiple Primary - epidemiology; Neoplasms, Multiple Primary - pathology; Neoplasms, Multiple Primary - surgery; Neoplasms, Second Primary - epidemiology; Neoplasms, Second Primary - pathology; Neoplasms, Second Primary - surgery; Original; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; Stomach Neoplasms - epidemiology; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Time Factors; Treatment Outcome; 내과학; Republic of Korea; Neoplasms, second primary; Neoplasms, multiple primary; Stomach neoplasms
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2013.28.6.687

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. 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. 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%. 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.