Re-Endoscopic Mucosal Resection for a Residual or Locally Recurrent Gastric Lesion after Endoscopic Mucosal Resection

Chang, Jae Hyuck; Lee, In Seok; You, Chan Ran; Nam, Kwan Woo; Kwon, Jung Hyun; Suh, Jung Pil; Park, Ho Sung; Paik, Chang Nyol; Park, Jae Myung; Cho, Yu Kyung; Kim, Sang Woo; Choi, Myung Gyu; Chung, In Sik

Abstract

BACKGROUND/AIMS: Re-endoscopic mucosal resection of a residual or locally recurrent gastric lesion after endoscopic mucosal resection (EMR) is often difficult due to submucosal fibrosis. The aim of this study was to investigate the factors related to the local recurrence of gastric lesions and the results of re-EMR.
METHODS
We retrospectively reviewed 245 patients with adenoma or early gastric cancer (EGC) treated by EMR. The factors related to local recurrence after EMR were analyzed. Ten patients with local recurrences after complete resection were treated with re-EMR and analyzed.
RESULTS
The mean size of the re-EMR lesions was 15.1 mm (5~30 mm). Seven patients were treated with endoscopic submucosal dissection (ESD) and three were treated with conventional EMR. En bloc resection was performed in eight patients (80%) and complete resection was performed in nine patients (90%). Bleeding was a complication of re-EMR in five patients (50%). There was no recurrent lesion after re-EMR in nine patients over a mean follow-up duration of 14.7 months. The local recurrence rate was significantly higher when the tumor was resected piecemeal (p<0.001).
CONCLUSIONS
Local recurrences occurred more frequently when the tumors were resected piecemeal. Re-EMR was a possible tool for the treatment of residual or locally recurrent lesions in 90% of the patients. Re-EMR may be the treatment of choice for a locally recurrent lesion after EMR according to the indication.