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Gudenkauf FJ, Mehta A, Ferri L, Aihara H, Draganov PV, Yang DJ, Jue TL, Munroe CA, Boparai ES, Mehta NA, Bhatt A, Kumta NA, Othman MO, Mercado M, Javaid H, Aadam AA, Siegel A, James TW, Grimm IS, DeWitt JM, Novikov A, Schlachterman A, Kowalski T, Samarasena J, Hashimoto R, Chehade NEH, Lee JG, Chang K, Su B, Ujiki MB, Sharaiha RZ, Carr-Locke DL, Chen A, Chen M, Chen YI, Tomizawa Y, von Renteln D, Kumbhari V, Khashab MA, Bechara R, Karasik M, Patel NJ, Fukami N, Nishimura M, Hanada Y, Song LMWK, Laszkowska M, Wang AY, Hwang JH, Friedland S, Sethi A, Ngamruengphong S. Factors Associated With Advanced Histological Diagnosis and Upstaging After Endoscopic Submucosal Dissection of Superficial Gastric Neoplasia. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2023; 25:2-10. [DOI: 10.1016/j.tige.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
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Arantes V, Aliaga Ramos J, Pedrosa MS. Endoscopic submucosal dissection for superficial gastric neoplasias in two referral hospitals in Brazil: Can the Japanese and South Korean results be equaled? REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:244-252. [PMID: 34210458 DOI: 10.1016/j.rgmxen.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 06/08/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND AIMS Endoscopic submucosal dissection (ESD) in the treatment of superficial neoplasias of the gastrointestinal tract is currently one of the greatest advances in therapeutic endoscopy. Due to its high technical complexity, it is not yet a routine procedure in Latin America. The aim of the present study was to present the experience in Brazil with ESD in superficial gastric neoplasias, based on training received from Japanese experts. MATERIALS AND METHODS A retrospective study was conducted, in which information was prospectively collected from a database that included all patients that underwent ESD due to superficial gastric neoplasias at two endoscopy referral centers in Brazil, within the time frame of June 2008 to June 2019. En bloc, complete, and curative resection rates were calculated, along with the local recurrence rate and adverse events. RESULTS A total of 103 ESDs for superficial gastric neoplasias were performed during the study period. Eighty of those patients (77.6%) presented with early malignant gastric neoplasias or premalignant lesions (adenocarcinoma: 52.5%, high-grade dysplasia: 27.5%, low-grade dysplasia: 16.3%, and neuroendocrine tumors: 3.8%). Overall en bloc and complete resection rates for the superficial gastric neoplasias were 96.3% and 92.5%, respectively, whereas the curative resection rate based on expanded criteria was 76%. CONCLUSIONS ESD for the treatment of superficial gastric neoplasias is a safe and effective therapeutic modality in Latin America, with results similar to those shown in the most representative Japanese studies.
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Affiliation(s)
- V Arantes
- Unidad de Endoscopia, Instituto Alfa de Gastroenterología, Facultad de Medicina, Universidad Federal de Minas Gerais, Hospital Mater Dei Contorno, Belo Horizonte, Minas Gerais, Brazil.
| | - J Aliaga Ramos
- Servicio de Gastroenterología Clínica San Pablo, Surco, Lima, Peru, Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Miembro de la Sociedad de Gastroenterología del Perú, Lima, Peru
| | - M S Pedrosa
- Departamento de Patología, Facultad de Medicina de la Universidad Federal de Minas Gerais, Belo Horizonte, Brazil
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Gweon TG, Kim BW, Kim JS, Park SM, Ji JS, Lee BI. Predictive Model of Nonneoplastic Pathology after Endoscopic Resection of Gastric Epithelial Neoplasia. Gut Liver 2020; 14:199-206. [PMID: 31060117 PMCID: PMC7096230 DOI: 10.5009/gnl18557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 11/04/2022] Open
Abstract
Background/Aims The rate of nonneoplastic pathology (NNP) after endoscopic resection (ER) of gastric epithelial neoplasia (GEN) has been reported to be 3%–7%. However, to date, the associations of pretreatment characteristics with NNP have not been identified. The aim of this study was to develop a predictive model for NNP after ER. Methods Among 817 patients who underwent ER for GEN, factors associated with NNP were identified by univariate and multivariate analyses. Weighted points considering the β coefficient were allocated to each variable that was significant in the multivariate analysis. The predictive score was calculated by the total points. The area under the receiver operating characteristic curve (AUROC) was calculated for the predictive score. Results The rate of NNP was 8.8%. After multivariate analysis, poor demarcation from the background, no ulceration, a flat appearance, and low-grade dysplasia were significant factors predictive of NNP. One point each was allocated for no ulcer, flat appearance, and low-grade dysplasia. Two points were allocated for poor demarcation from the background. The predictive score ranged from 0 to 5 points. Patients were categorized as being at low risk (0, 1, or 2 points) or high risk (3, 4, or 5 points) for NNP. The AUROC was 0.82 (95% confidence interval, 0.77 to 0.88; p<0.01). With a cutoff value of 2.5, the sensitivity and specificity of the score for predicting NNP were 0.72 and 0.84, respectively. Conclusions We developed a model to predict NNP after ER. Endoscopic re-biopsy or re-evaluation by pathologists is strongly recommended for the high-risk group.
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Affiliation(s)
- Tae-Geun Gweon
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Min Park
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Seon Ji
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo In Lee
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee DS, Park JK, Lee SJ, Cheon GJ. Clinical significance of regional lymph node enlargement in patients with EGC within the expanded criteria for ESD. BMC Gastroenterol 2020; 20:51. [PMID: 32138692 PMCID: PMC7059300 DOI: 10.1186/s12876-020-01197-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Lymph node (LN) metastasis is negligible in early gastric cancer (EGC) within expanded criteria for endoscopic submucosal dissection (ESD). However, regional lymph nodes in abdominal CT scans are sometimes enlarged in patients with EGC within the expanded criteria for endoscopic submucosal dissection (ESD). In this study, we investigated the clinical significance of regional lymph node enlargement on abdominal CT scan in patients with EGC within the expanded criteria for ESD. METHODS From December 2010 to April 2015, among 301 patients with EGC within the ESD expanded criteria, 47 patients with regional lymph node enlargement shown by abdominal CT scan were prospectively enrolled. We performed surgical resection or periodic follow-up with abdominal CT scans and upper endoscopy every 6 months to evaluate whether the enlarged lymph nodes are due to metastasis or a reactive change. RESULTS The mean age of the 47 patients (38 males, 9 female) was 64.8 years. The enlarged lymph nodes were usually single (26/47, 44.6%) and sized as follows: 11 nodes were ≤ 5 mm, 19 were 6-10 mm, and 17 were ≥ 10 mm. Four of the 47 patients initially underwent surgical resection, and 8 patients underwent surgical resection after ESD. However, there was no lymph node metastasis in surgical specimens. Thirty-five patients received ESD and periodically followed up at a median duration of 56 months (IQR: 44-59 month). The enlarged lymph node disappeared in 12 of 35 patients, decreased in 9 patients and remained the same size in 13 patients, and increased in 1 patient. CONCLUSION Regional lymph node enlargement on abdominal CT scan in patients within expanded criteria for ESD of ECG may be not due to metastasis but a reactive change.
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Affiliation(s)
- Dong Seok Lee
- Department of Gastroenterology, SMG-SNU Boramae Medical Center, Seoul National University of College of Medicine, Seoul, South Korea
| | - Jong Kyu Park
- Department of Gastroenterology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Sang Jin Lee
- Department of Gastroenterology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Gab Jin Cheon
- Department of Gastroenterology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
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Cryptic Early Gastric Carcinoma in Gastric Stump: Challenges in Diagnostic Evaluation. Case Rep Pathol 2019; 2019:1794370. [PMID: 31929929 PMCID: PMC6935802 DOI: 10.1155/2019/1794370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/29/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Partial gastrectomy, performed for any indication, is a well-recognized risk factor for carcinoma developing in the gastric remnant (so-called “gastric stump carcinoma”). In symptomatic patients with gastro-enteric anastomosis, it is a common practice to endoscopically evaluate the patency and the status of the anastomosis and procure biopsy samples when endoscopic abnormalities are noted. We describe a case with Billroth I gastroduodenal anastomosis with oozing and friability at the anastomosis site which was biopsied. The biopsies showed invasive intestinal-type adenocarcinoma. Subsequent completion gastrectomy showed no grossly visible tumor and required extensive initial and additional sampling of the anastomosis and the surrounding stomach to locate a small focus of invasive adenocarcinoma limited to the mucosa (“early gastric carcinoma”). This case illustrates a known complication of partial gastrectomy and highlights challenges in diagnostic evaluation of early gastric carcinoma after gastrectomy.
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Noh CK, Jung MW, Shin SJ, Ahn JY, Cho HJ, Yang MJ, Kim SS, Lim SG, Lee D, Kim YB, Cheong JY, Lee KM, Yoo BM, Lee KJ. Analysis of endoscopic features for histologic discrepancies between biopsy and endoscopic submucosal dissection in gastric neoplasms: 10-year results. Dig Liver Dis 2019; 51:79-85. [PMID: 30236767 DOI: 10.1016/j.dld.2018.08.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM The histologic discrepancies between preoperative endoscopic forceps biopsy (EFB) and endoscopic submucosal dissection (ESD) specimens sometimes confuse the endoscope operator. This study aimed to analyze the limitation of the biopsy-based diagnosis before ESD and to evaluate which factors affect the discordant pathologic results between EFB and ESD. METHODS A total of 1427 patients, who were diagnosed with gastric adenoma by EFB, were enrolled. Cancer confirmed on EFB was excluded (n = 513). We retrospectively reviewed cases and compared histologic diagnoses in the biopsy sample with the final diagnosis in the endoscopically resected specimen. RESULTS The diagnosis was upgraded (from low-grade dysplasia to high-grade dysplasia or adenocarcinoma, or from high-grade dysplasia to adenocarcinoma) in 328 cases (23.0%), concordant in 944 (66.1%), and downgraded (from high-grade dysplasia to low-grade dysplasia or non-neoplasia, or from low-grade dysplasia to non-neoplasia) in 155 (10.9%). Multivariate logistic regression analysis showed that surface ulceration and depressed lesions were associated with significant risk factors for upgrading. Age younger than 60 years and size <1 cm were associated with significant factors for downgrading. CONCLUSIONS Careful endoscopic observation should consider size, ulceration, and depression to ensure accurate diagnosis when a gastric neoplasm is suspected.
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Affiliation(s)
- Choong-Kyun Noh
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Min Wook Jung
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sung Jae Shin
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Ju Young Ahn
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyo Jung Cho
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min Jae Yang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Soon Sun Kim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dakeun Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Bae Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jae Youn Cheong
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kee Myung Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Byung Moo Yoo
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kwang Jae Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
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Kwon YH. Negative Histology after Endoscopic Resection: How to Avoid It. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2018. [DOI: 10.7704/kjhugr.2018.18.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yong Hwan Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Shin SJ, Yang MJ, Noh CK, Lim SG, Lee KM, Lee KJ. Negative Histology after Endoscopic Resection: An Endoscopist's Aspect. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2018. [DOI: 10.7704/kjhugr.2018.18.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sung Jae Shin
- Division of Gastroenterology, Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Min Jae Yang
- Division of Gastroenterology, Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Choong-Kyun Noh
- Division of Gastroenterology, Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Sun Gyo Lim
- Division of Gastroenterology, Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Kee Myung Lee
- Division of Gastroenterology, Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Jae Lee
- Division of Gastroenterology, Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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Kang DH, Choi CW, Kim HW, Park SB, Kim SJ, Nam HS, Ryu DG. Predictors of upstage diagnosis after endoscopic resection of gastric low-grade dysplasia. Surg Endosc 2017; 32:2732-2738. [PMID: 29214514 DOI: 10.1007/s00464-017-5971-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 10/29/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The optimal management of precursor lesions such as gastric low-grade dysplasia is crucial in order to improve gastric cancer-related mortality. However, there are no universally accepted management guidelines regarding which lesions should be resected or should be monitored by follow-up visits. PATIENTS AND METHODS We retrospectively analyzed data from 1006 gastric low-grade dysplasia lesions that had been resected via endoscopic submucosal dissection. We also evaluated the endoscopic risk factors associated with upstage diagnosis from low-grade dysplasia to high-grade dysplasia or gastric cancer. RESULTS The mean age of our patients was 63.7 ± 9.1 years and 70.3% of our study population included men. The predominant location and gross type of lesions was the lower third of the stomach (78.6%) and the elevated type (57.8%), respectively. The rates of pathological concordance, upstage, and downstage diagnosis were 85.3, 12.1, and 2.6%, respectively. Multivariate analysis, after adjusting for age and sex, showed that a lesion size ≥ 10 mm (Odds ratio [OR] 2.231; p = 0.003), erythema (OR 7.315; p < 0.001), nodularity (OR 5.589; p < 0.001), depression (OR 3.024; p = 0.002), and erosion (OR 7.680; p < 0.001) were all factors significantly associated with upstage diagnosis. Furthermore, an increasing number of risk factors was associated with an increasing frequency of upstage diagnosis; if there were no risk factors, then there was no upstage diagnosis. CONCLUSIONS This study identified several risk factors that were significantly associated with the upstage diagnosis of gastric low-grade dysplasia: lesion size ≥ 10 mm and a variety of surface changes (erythema, nodularity, depression, and erosion). Our data indicate that if there is no evidence of these endoscopic risk factors, then regular follow-up may be considered, according to the patient's combined comorbid conditions.
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Affiliation(s)
- Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea. .,Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, South Korea.
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hyeong Seok Nam
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Jhi JH, Kim GH, Kim A, Kim YG, Hwang CS, Lee S, Lee BE, Song GA, Park DY. Negative pathology after endoscopic resection of gastric epithelial neoplasms: importance of pit dysplasia. Korean J Intern Med 2017; 32:647-655. [PMID: 28103435 PMCID: PMC5511931 DOI: 10.3904/kjim.2015.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 09/16/2015] [Accepted: 09/21/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic resection (ER) is a well-established treatment modality for gastric epithelial neoplasm. However, there is a discrepancy between forceps biopsy and ER specimen pathology, including a negative pathologic diagnosis (NPD) after ER. It has been suggested that pit dysplasia (PD) is a subtype of gastric dysplasia, and the aim of this study was to assess the significance of PD in cases with NPD after ER for early gastric neoplasms. METHODS After ER, 29 NPD lesions that had an associated pretreatment forceps biopsy specimen, were correctly targeted during ER, and had no cautery artifact on the resected specimen were included in this study. RESULTS Sixteen lesions showed PD and 13 had no neoplastic pathology. The initial pretreatment forceps biopsy diagnoses of 29 NPD lesions were low-grade dysplasia (LGD) in 17 lesions, high-grade dysplasia (HGD) in seven lesions, and adenocarcinoma in five lesions, which after review were revised to PD in 19 lesions, LGD in four lesions, adenocarcinoma in two lesions, and no neoplastic pathology in four lesions. Overall, nine lesions (31%) were small enough to be removed by forceps biopsy, four NPD lesions (14%) were initially misinterpreted as neoplastic lesions, and 16 PD lesions (55%) were misinterpreted as NPD lesions on ER slides. CONCLUSIONS Approximately half of the lesions initially diagnosed as LGD or HGD were subsequently classified as PD. Therefore, including PD as a subtype of gastric dysplasia could reduce the diagnostic discrepancy between initial forceps biopsy and ER specimens.
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Affiliation(s)
- Joon Hyung Jhi
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ahrong Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Young-Geum Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Cheong Su Hwang
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Sojeong Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Do Youn Park
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
- Correspondence to Do Youn Park, M.D. Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeokro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7717 Fax: +82-51-256-0788 E-mail:
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Kwon YH, Jeon SW, Nam SY, Lee HS, Kim JS, Park JY. Long-Term Outcome After Endoscopic Submucosal Dissection for Early Gastric Cancer in Non-neoplastic Pathology Results. Dig Dis Sci 2017; 62:1313-1320. [PMID: 28283849 DOI: 10.1007/s10620-017-4520-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/28/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND After endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), negative pathological findings cause concern about the adequacy of the procedure and local recurrence after ESD. AIM To investigate the incidence of local recurrence in cases with negative pathological findings after ESD for EGC and pathologically complete resection (CR) during long-term follow-up. METHODS We reviewed 453 patients who underwent ESD for ECG from January 2007 to December 2010, respectively. Of these patients, in 17 cases the pathology results confirmed no residual tumor (NRT), and in 421 cases they showed CR in the ESD specimen. Finally, 17 NRT and 358 CR cases were followed up during surveillance. Patient characteristics, endoscopic and pathological data were analyzed for risk factors of local recurrence. We also re-evaluated the pathology of the NRT group to identify hidden malignant cells in the previous ESD specimens. RESULTS There was no difference between the two groups in terms of recurrence during follow-up surveillance (median 55.7 months). Late local recurrence of EGC was found in two cases (11.8%) in the NRT group, and three early local recurrences (5.6%) were found in the CR group. A review of the pathology in the NRT group revealed hidden malignant cells in five patients (29.4%). CONCLUSIONS Even when the pathological report indicates NRT after ESD, it might be necessary to re-evaluate ESD specimens with a width <2 mm, and long-term endoscopic surveillance should be routinely used for detecting local EGC recurrence after ESD.
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Affiliation(s)
- Yong Hwan Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gastric Cancer Center, Kyungpook National University Medical Center, 807, Hogukno, Buk-gu, Daegu, 702-210, South Korea
| | - Seong Woo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gastric Cancer Center, Kyungpook National University Medical Center, 807, Hogukno, Buk-gu, Daegu, 702-210, South Korea.
| | - Su Youn Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gastric Cancer Center, Kyungpook National University Medical Center, 807, Hogukno, Buk-gu, Daegu, 702-210, South Korea
| | - Hyun Seok Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gastric Cancer Center, Kyungpook National University Medical Center, 807, Hogukno, Buk-gu, Daegu, 702-210, South Korea
| | - Jeong Shik Kim
- Department of Pathology, Kyungpook National University Medical Center, Daegu, South Korea
| | - Ji Young Park
- Department of Pathology, Kyungpook National University Medical Center, Daegu, South Korea
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Gong EJ, Lee JH, Jung K, Cho CJ, Na HK, Ahn JY, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY, Kim JH. Characteristics of Missed Simultaneous Gastric Lesions Based on Double-Check Analysis of the Endoscopic Image. Clin Endosc 2016; 50:261-269. [PMID: 27545277 PMCID: PMC5475516 DOI: 10.5946/ce.2016.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/03/2016] [Accepted: 07/27/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS The detection of multifocal lesions is important for the successful management of gastric neoplasms. We investigated the characteristics of missed simultaneous lesions and the reason for the missed diagnoses. METHODS A total of 140 patients who underwent repeat endoscopy before endoscopic resection between June 2013 and June 2014 were retrospectively reviewed. We classified simultaneous lesions into three groups based on a review of earlier images: group 1, no images of the location of simultaneous lesions were taken; group 2, no corresponding lesion was evident in the previous images; and group 3, simultaneous lesions were visible in the earlier images but a biopsy was not performed. RESULTS Simultaneous lesions were found in 12 patients (8.6%) with 13 lesions, comprising 10 dysplasia (76.9%) and three adenocarcinoma (23.1%). Regarding the reasons for missed diagnoses, seven lesions (53.8%) were classified as group 3, five (38.5%) as group 1, and the remaining lesion (7.7%) as group 2. There were no significant differences in the characteristics of the patients with and without simultaneous lesions. CONCLUSIONS Lesions disregarded or unnoticed during endoscopic examination were the main reason for missed diagnosis of simultaneous lesions. Endoscopists should consider the possibility of simultaneous lesions and attempt to meticulously evaluate the entire gastric mucosa.
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Affiliation(s)
- Eun Jeong Gong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungwon Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Charles J Cho
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Clinical features of negative pathologic results after gastric endoscopic submucosal dissection. Surg Endosc 2016; 31:1163-1171. [PMID: 27405480 DOI: 10.1007/s00464-016-5086-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/05/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is widely used for the treatment of gastric superficial neoplasms. Negative pathologic results after ESD can confuse the endoscopists and patients. The aim of this study was to evaluate the reasons for and the factors associated with negative pathologic results after ESD. PATIENTS AND METHODS From December 2008 to July 2015, a total of 1379 lesions diagnosed as definite dysplasia or adenocarcinoma by endoscopic forceps biopsy (EFB) were removed with an ESD procedure. The initial endoscopic and pathologic findings were analyzed. RESULTS The incidence of negative pathology after ESD was 2.0 % (28/1379). Compared with positive pathologic lesions, negative pathologic lesions were smaller and had less surface area (P < 0.001). The reasons for negative pathologic lesions after ESD were complete removal by EFB (n = 20), over-estimations of the EFB specimen (n = 5), and different ESD site (n = 3). CONCLUSION Small tumor size and surface area are associated with negative pathologic results after ESD. When negative pathologic results are reported after ESD, we should review the previous endoscopic biopsy tissue specimen and compare the previous EFB site to the ESD site. Thereafter, regular endoscopic examination of the lesion is needed.
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14
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Diagnostic group classifications of gastric neoplasms by endoscopic resection criteria before and after treatment: real-world experience. Surg Endosc 2015; 30:3987-93. [PMID: 26694184 DOI: 10.1007/s00464-015-4710-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/27/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND STUDY AIMS There are often discrepancies between the pretreatment evaluation of gastric neoplasms by endoscopy with biopsy and the final diagnosis of resected specimen in terms of pathology and depth of invasion. We evaluated the spectrum of discrepancies between pretreatment and posttreatment diagnosis which may deliver significant differences on clinical practice. PATIENTS AND METHODS A total of 2041 patients with gastric dysplasia or cancer who underwent curative endoscopic resections or surgeries in 2012 were enrolled. Patients were classified into five different diagnostic groups: low-grade dysplasia (LGD), high-grade dysplasia (HGD), absolute indication early gastric cancer (AI-EGC), beyond absolute indication early gastric cancer (BAI-EGC), and advanced gastric cancer (AGC). The choice of initial treatment and final pathologic diagnosis was analyzed. RESULTS The study patients belonged to the following pretreatment diagnostic groups: LGDs in 162, HGDs in 164, AI-EGCs in 396, BAI-EGCs in 824, and AGCs in 495 cases. Posttreatment diagnostic groups were LGDs in 140, HGDs in 121, AI-EGCs in 322, BAI-EGCs in 947, AGCs in 505, and no residual tumor in 6 cases. In general, 6.9 % (141/2041) of cases were downgraded and 15.9 % (324/2041) were upgraded. Thirty-four percent of pretreatment HGDs (56/164) were changed to cancers after endoscopic resection. Thirty-three percent of pretreatment AI-EGCs (131/396) were regrouped as posttreatment BAI-EGCs. The additional surgery rate in each pretreatment group was 0.6 % in LGD, 4.3 % in HGD, 15.7 % in AI-EGC, 23.6 % in BAI-EGC among the patients with initial endoscopic resection (p < 0.01). CONCLUSIONS Twenty-three percent of gastric neoplasms changed in their final diagnostic group after endoscopic resection or surgery. This discrepancy should be considered when the initial treatment strategy is being selected.
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