Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2018; 24(33): 3776-3785
Published online Sep 7, 2018. doi: 10.3748/wjg.v24.i33.3776
Secondary endoscopic submucosal dissection for locally recurrent or incompletely resected gastric neoplasms
Da Hyun Jung, Young Hoon Youn, Jie-Hyun Kim, Jae Jun Park, Hyojin Park
Da Hyun Jung, Young Hoon Youn, Jie-Hyun Kim, Jae Jun Park, Hyojin Park, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
Author contributions: All authors performed the research; Jung DH contributed to manuscript writing, performing procedures, and data analysis; Youn YH contributed to manuscript writing, conception and design, performing procedures, and data analysis; Kim JH, Park JJ, and Park H contributed to writing the manuscript and performing procedures.
Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF) funded by the Ministry of Science and ICT(NRF-2015R1C1A1A01054352).
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Gangnam Severance Hospital.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
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:
Correspondence to: Young Hoon Youn, MD, PhD, Associate Professor, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 06273, South Korea.
Telephone: +82-2-20193453 Fax: +82-2-34633882
Received: June 11, 2018
Peer-review started: June 11, 2018
First decision: July 6, 2018
Revised: July 31, 2018
Accepted: August 1, 2018
Article in press: August 1, 2018
Published online: September 7, 2018
Research background

Endoscopic submucosal dissection (ESD) is an accepted curative treatment option for gastric tumors with very low local recurrence. However, residual or locally recurrent tumors occur rarely after ESD. Although secondary ESD is technically demanding, it can be applied to residual or recurrent tumors with scar and dense fibrotic submucosa. We investigated the feasibility and safety of secondary ESD for gastric tumors. We also categorized secondary ESD into three groups according to the surgical strategy (early salvage, late salvage, or late secondary ESD) and analyzed them.

Research motivation

There is no consensus on the timing of salvage ESD. Until now, there were few reports about the feasibility and effectiveness of early salvage ESD.

Research objectives

To investigate the feasibility and safety of secondary ESD for residual or locally recurrent gastric tumors.

Research methods

Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups.

Research results

The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%. The average procedure time of secondary ESD was significantly longer than primary ESD, and the adverse events rate was not statistically different but trended slightly higher in the secondary ESD group compared to the primary ESD group. Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD.

Research conclusions

Although it requires greater technical efficiency and longer procedure time, secondary ESD of residual or locally recurrent gastric tumors appears to be feasible and curative treatment.

Research perspectives

Secondary ESD of residual or locally recurrent gastric tumors is a feasible and curative treatment.