Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2017; 23(23): 4262-4269
Published online Jun 21, 2017. doi: 10.3748/wjg.v23.i23.4262
Clinical importance of colonoscopy in patients with gastric neoplasm undergoing endoscopic submucosal dissection
Chieko Tsuchida, Naoto Yoshitake, Hitoshi Kino, Yoshihito Kaneko, Masakazu Nakano, Kohei Tsuchida, Keiichi Tominaga, Takako Sasai, Hironori Masuyama, Hidetsugu Yamagishi, Yasuo Imai, Hideyuki Hiraishi
Chieko Tsuchida, Naoto Yoshitake, Hitoshi Kino, Yoshihito Kaneko, Masakazu Nakano, Kohei Tsuchida, Keiichi Tominaga, Takako Sasai, Hironori Masuyama, Hideyuki Hiraishi, Department of Gastroenterology, Dokkyo Medical University, Shimotsuga, Tochigi 321-0293, Japan
Hidetsugu Yamagishi, Yasuo Imai, Department of Diagnostic Pathology, Dokkyo Medical University, 880, Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan
Author contributions: Tsuchida C and Yoshitake N were involved in the design of this study; Tsuchida C, Yoshitake N, Kino H, Kaneko Y, Nakano M and Tsuchida K performed the endoscopic treatment; Tsuchida C, Yoshitake N, Kino H, Kaneko Y and Nakano M conducted data collection and statistical analysis; The manuscript was written by Tsuchida C and Yoshitake N, and Tominaga K, Sasai T, Masuyama H, Yamagishi H, Imai Y and Hiraishi H provided advice on the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the ethics committee of Dokkyo Medical University.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naoto Yoshitake, MD, PhD, Department of Gastroenterology, Dokkyo Medical University, 880, Kitakobayashi, Mibu, Shimotsuga, Tochigi 321-0293, Japan. naoto-y@dokkyomed.ac.jp
Telephone: +81-282-872147 Fax: +81-282-867761
Received: December 17, 2016
Peer-review started: December 20, 2016
First decision: March 16, 2017
Revised: March 29, 2017
Accepted: May 19, 2017
Article in press: May 19, 2017
Published online: June 21, 2017
Abstract
AIM

To evaluate the usefulness of total colonoscopy (TCS) for patients undergoing gastric endoscopic submucosal dissection (ESD) and to assess risk factors for colorectal neoplasms.

METHODS

Of the 263 patients who underwent ESD at our department between May 2010 and December 2013, 172 patients undergoing TCS during a one-year period before and after ESD were targeted. After excluding patients with a history of surgery or endoscopic therapy for colorectal neoplasms, 158 patients were analyzed. Of the 868 asymptomatic patients who underwent TCS during the same period because of positive fecal immunochemical test (FIT) results, 158 patients with no history of either surgery or endoscopic therapy for colorectal neoplasms who were matched for age and sex served as the control group for comparison.

RESULTS

TCS revealed adenoma less than 10 mm in 53 patients (33.6%), advanced adenoma in 17 (10.8%), early colorectal cancer in 5 (3.2%), and advanced colorectal cancer in 4 (2.5%). When the presence or absence of adenoma less than 10 mm, advanced adenoma, and colorectal cancer and the number of adenomas were compared between patients undergoing ESD and FIT-positive patients, there were no statistically significant differences in any of the parameters assessed. The patients undergoing ESD appeared to have the same risk of colorectal neoplasms as the FIT-positive patients. Colorectal neoplasms were clearly more common in men than in women (P = 0.031). Advanced adenoma and cancer were significantly more frequent in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus (P = 0.019).

CONCLUSION

In patients undergoing gastric ESD, TCS appears to be important for detecting synchronous double neoplasms. Advanced adenoma and cancer were more common in patients with at least two of the following conditions: hypertension, dyslipidemia, and diabetes mellitus. Caution is therefore especially warranted in patients with these risk factors.

Keywords: Colonoscopy, Colorectal neoplasm, Gastric neoplasm, Endoscopic submucosal dissection, Fecal immunochemical test

Core tip: This is a retrospective study to evaluate the usefulness of total colonoscopy (TCS) for patients undergoing gastric endoscopic submucosal dissection (ESD). The frequency of detecting colorectal lesions, especially advanced adenoma and carcinoma, was higher in patients with early gastric cancer or gastric adenoma. This observation suggests that such patients are at a risk equivalent to that of fecal immunochemical test positive patients, suggesting that screening TCS should be performed as extensively as possible in patients undergoing ESD.