The diagnostic efficacy of endoscopic mucosal resection (EMR) in gastric flat adenoma

Hyun, Dong Woo; Park, Jin Hyung; Park, Chang Kun; Yun, Young Mi; Cho, Chang Min; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan

Abstract

BACKGROUND: EMR is an alternative to surgical removal of superficial neoplastic lesions of the gastrointestinal tracts. The aim of this study is to assess the diagnostic efficacy of EMR in gastric flat adenoma.
METHODS
Ninety five lesions of gastric flat adenoma removed by EMR in 89 patients were enrolled in this study at Kyungpook National University Hospital from January 1999 to June 2002. We have analysed diagnostic efficacy of EMR in gastric flat adenoma.
RESULTS
Tubular adenoma were 78 cases (82.1%), tubular adenoma with high grade dysplasia were 16 cases (16.8%) and villous adenoma was 1 case (1.1%). Locations were antrum 57 cases (60.0%), body 22 cases (23.1%), angle 14 cases (14.7%), pylorus 1 case (1.1%) and cardia 1 case (1.1%). Among 95 lesions of gastric flat adenoma, 26 cases (27.4%) revealed upgraded histologic diagnosis between endoscopic biopsy and EMR. Twenty two lesions (37.3%) among 59 lesions that were 1cm size or more were upgraded in the histologic staging to carcinoma or high grade dysplasia, compared with 4 lesions (11.1%) among 36 lesions less than 1cm size (p<0.01). Eight lesions (50.0%) among 16 lesions diagnosed in tubular adenoma with high grade dysplasia were upgraded in the histologic staging to carcinoma, compared with 12 lesions (15.4%) among 78 lesions diagnosed in tubular adenoma (p<0.01). Bleeding was the only complication and occurred in 24 lesions (25.3%).
CONCLUSION
EMR resulted in upgrading of the histologic staging to carcinoma or high grade dysplasia in 27.4% of gastric flat adenomas.