Clin Endosc.  2014 Jul;47(4):353-357. 10.5946/ce.2014.47.4.353.

A Case of Endoscopic Full-Thickness Resection in a Patient with Gastric High-Grade Dysplasia Unsuitable for Endoscopic Submucosal Dissection

• Chae JM
• Jang JY
• Hong S
• Kim JW
• Chang YW

• KMID: 1907938
• DOI: http://doi.org/10.5946/ce.2014.47.4.353

Abstract

Gastric high-grade dysplasia is an important premalignant lesion in gastric epithelial cells and has a high possibility of transforming to adenocarcinoma. Therefore, biopsy-proven high-grade dysplasia should be treated with en bloc resection methods such as endoscopic mucosal resection or endoscopic submucosal dissection (ESD). We report the case of a 63-year-old male patient, diagnosed with gastric high-grade dysplasia at the angle and lesser curvature side of the lower body. The patient was initially treated with ESD, although histopathology subsequently showed horizontal margin involvement. Since the lesion was diffusely edematous and margins were uncertain because of the previous ESD treatment, we chose to treat the patient with laparoscopy-assisted endoscopic full-thickness resection (EFTR). EFTR is a recently developed procedure, which uses both endoscopic and laparoscopic techniques to resect the full-thickness of the tissue. The final pathologic report revealed high-grade dysplasia and a focal intramucosal carcinoma of 0.8x0.7 cm. We conclude that EFTR can be an effective alternative treatment in gastric high-grade dysplasia unsuitable for ESD.

Keyword

High-grade dysplasia; Endoscopic full-thickness resection; Endoscopic submucosal dissection

MeSH Terms

Adenocarcinoma
Epithelial Cells
Humans
Male
Middle Aged

Figure

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  Fig. 1 Initial endoscopic findings 2 months before referral.

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  Fig. 2 Endoscopic findings before endoscopic submucosal dissection. (A) Discolored and nodular lesion located at the lesser curvature of the low body. (B) Diffuse nodularity observed at the angle. Both lesions were confirmed as high-grade dysplasia after biopsy.

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  Fig. 3 Endoscopic full-thickness resection after failed endoscopic submucosal dissection. (A) The successfully sealed lesion. (B) The circumferential submucosal incision. (C) The punctured lesion. (D) Completed full-thickness resection.

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  Fig. 4 Histopathology results. High-grade dysplasia with a focal intramucosal cancer of 0.8×0.7 cm (H&E stain, ×100).

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