Retrospective Study
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World J Gastroenterol. Jul 14, 2014; 20(26): 8631-8637
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8631
Impact of tumor location on clinical outcomes of gastric endoscopic submucosal dissection
Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park
Ji Young Yoon, Choong Nam Shim, Sook Hee Chung, Wan Park, Hyunsoo Chung, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee, Jun Chul Park, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul 120-752, South Korea
Author contributions: Yoon JY and Shim CN contributed equally to this work; all the authors participated in this study.
Supported by A Faculty Research Grant of Yonsei University College of Medicine for 2010, No. 6-2010-0145
Correspondence to: Jun Chul Park, MD, Assistant Professor, Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. junchul75@yuhs.ac
Telephone: +82-2-22282272 Fax: +82-2-3936884
Received: November 5, 2013
Revised: February 13, 2014
Accepted: March 12, 2014
Published online: July 14, 2014
Abstract

AIM: To determine whether there is a correlation between the location of the lesion and endoscopic submucosal dissection (ESD) outcome.

METHODS: From January 2008 to December 2010, ESD of 1443 gastric tumors was performed. En bloc resection rate, complete resection rate, procedure time and complication rate were analyzed according to the tumor location.

RESULTS: The rates of en bloc resection and complete resection were 91% (1318/1443) and 89% (1287/1443), respectively. The post-ESD bleeding rate was 4.3%, and perforation rate was 2.7%. Tumors located in the upper third of the stomach were associated with a longer procedure time and significantly higher rates of incomplete resection, piecemeal resection, and perforation than tumors below the upper third of the stomach. Posterior wall lesions had significantly longer procedure times and higher rates of incomplete resection and piecemeal resection than lesions in other locations. In multivariate analysis, posterior wall lesions and upper third lesions were significantly associated with incomplete resection and perforation, respectively. In post-ESD bleeding analysis, location was not a significant related factor.

CONCLUSION: More advanced endoscopic techniques are required during ESD for lesions located in the upper third or posterior wall of the stomach to decrease complications and improve therapeutic outcomes.

Keywords: Endoscopic submucosal dissection, Gastric neoplasm, Location, Complication, Outcomes

Core tip: Location of the tumor is one of the most important clinical factors for complete resection and complications of endoscopic submucosal dissection (ESD) for early gastric cancer. Nonetheless, few studies have evaluated clinicopathologic outcomes of ESD according to the subdivision of tumor location. Based on our data, posterior wall lesions and upper third lesions were significantly associated with incomplete resection and perforation, respectively. Therefore, endoscopists should recognize the need for more advanced endoscopic techniques when performing ESD for lesions located in the upper third or posterior wall of the stomach to decrease the rate of serious complications and improve clinical outcomes.