Korean J Intern Med.  2013 Nov;28(6):687-693. 10.3904/kjim.2013.28.6.687.

Clinicopathological characteristics of synchronous and metachronous gastric neoplasms after endoscopic submucosal dissection

• Jang MY
• Cho JW
• Oh WG
• Ko SJ
• Han SH
• Baek HK
• Lee YJ
• Kim JW
• Jung GM
• Cho YK

• KMID: 1780129
• DOI: http://doi.org/10.3904/kjim.2013.28.6.687

Abstract

BACKGROUND/AIMS
Endoscopic submucosal dissection (ESD) has become accepted as a minimally invasive treatment for gastric neoplasms. However, the development of synchronous or metachronous gastric lesions after endoscopic resection has become a major problem. We investigated the characteristics of multiple gastric neoplasms in patients with early gastric cancer (EGC) or gastric adenoma after ESD.
METHODS
In total, 512 patients with EGC or gastric adenoma who had undergone ESD between January 2008 and December 2011 participated in this study. The incidence of and factors associated with synchronous and metachronous gastric tumors were investigated in this retrospective study.
RESULTS
In total, 66 patients (12.9%) had synchronous lesions, and 13 patients (2.5%) had metachronous lesions. Older (> 65 years) subjects had an increased risk of multiple gastric neoplasms (p = 0.012). About two-thirds of the multiple lesions were similar in macroscopic and histological type to the primary lesions. The median interval from the initial lesions to the diagnosis of metachronous lesions was 31 months. The annual incidence rate of metachronous lesions was approximately 3%.
CONCLUSIONS
We recommend careful follow-up in patients of advanced age (> 65 years) after initial ESD because multiple lesions could be detected in the remnant stomach. Annual surveillance might aid in the detection of metachronous lesions. Large-scale, multicenter, and longer prospective studies of appropriate surveillance programs are needed.

Keyword

Stomach neoplasms; Neoplasms, multiple primary; Neoplasms, second primary

MeSH Terms

Adenoma/epidemiology/pathology/*surgery
Age Factors
Aged
*Dissection
Female
Gastrectomy/*methods
Gastric Mucosa/pathology/*surgery
*Gastroscopy
Humans
Incidence
Male
Middle Aged
Neoplasms, Multiple Primary/epidemiology/pathology/*surgery
Neoplasms, Second Primary/epidemiology/pathology/*surgery
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Stomach Neoplasms/epidemiology/pathology/*surgery
Time Factors
Treatment Outcome