The Study of Pathologic Difference between Endoscopic Biopsy before EMR and Histology of Specimen after Endoscopic Mucosal Resection (EMR) on Gastric Flat Adenoma or Early Gastric Cancer (EGC) / 대한소화기내시경학회지

BACKGROUND/AIMS: It is not uncommon to show discrepancy between the histology of the endoscopic biopsy and that of the resected specimen obtained from the same lesion by EMR. The aim of this study was to ascertain whether routine endoscopic biopsy specimens are sufficient to qualify the representative enough to reliable indication of EMR. METHODS: We retrospectively reviewed 36 cases that could be compared the histologic results from the resected specimens by EMR to the tissue obtained by endoscopic biopsy. The histologic slides were reviewed by one pathologist. RESULTS: Of the 36 cases, 13 cases of EGC and 23 cases of gastric flat adenomas were included. Among 13 cases of EGC, 2 case (15.4%) revealed discrepancy between the histology of the endoscopic biopsy and that of a resected specimen by EMR. The histology of a resected specimen by EMR revealed moderate differentiated adenocarcinoma, while that of endoscopic biopsy was a well differentiated adenocarcinoma. Gastric flat adenoma revealed 47.8% (11/23) of discrepancy. CONCLUSIONS: The histologic discrepancy between the result of endoscopic biopsy and that of the resected specimen obtained by EMR was about 8% in EGC and 47.8% in gastric flat adenoma.

A Clinical Study of Protruding Lesions That Arise at the Scar of an Endoscopic Mucosal Resection for an Early Gastric Carcinoma and a Gastric Flat Adenoma

PURPOSE: Several studies of an endoscopic mucosal resection (EMR) have been reported, but reports about benign protruding lesions that arise at the scar of EMR for early gastric cancer (EGC) or a gastric adenoma are rare. The purpose of this study was to elucidate endoscopic and histological characteristics of benign protruding lesions which arise at the scar of an EMR for EGC and a gastric flat adenoma. MATENRIALS AND METHODS: In 101 lesions (73 gastric flat adenomas and 28 EGCs) from 96 patients, 16 lesions developed new protruding lesions that arose at the scar of the EMR. We retrospectively analyzed the endoscopic findings of initial and protruding lesions, and several other clinical factors (H. pylori infection, eradication therapy, and proton pump inhibitor (PPI) or H2-blocker use). RESULTS: 1. The mean duration until detection of the protruding lesion was 8.9 months (1.5~7). Protruding lesions arose at the scar of the EMR in 1 of 28 EGCs (3.6%) and from 15 of 73 gastric flat adenomas (20.5%). All of the patients were men. 2. With respect to the endoscopic findings, the shapes of the protruding lesions were as follows: 10 Yamada (Y) I, 4 Y-II, 1 Y-III, and 1 flat lesion. Histological examination of the protruding lesions revealed regenerating hyperplasia in 5 lesions, intestinal metaplasia in 5, and both in 6. 3. The incidence of these lesions was higher in cases of tubular adenomas with focal high-grade dysplasia than in cases of tubular adenomas without dysplasia (p<0.05). 4. The incidence of H. pylori infection was higher in patients (81.7%) who developed a protruding lesion than in those (51.8%) who did not develop (p=0.029); also, the incidence of use of PPI was higher in those patients (p=0.045). However, eradication therapy for H. pylori and duration of use of PPI or H2-blocker showed no difference between groups. CONCLUSION: It may be possible that the potential hyperplasia that may reside in normal mucosa surrounding EGC or a gastric adenoma might awaken during the healing process of the EMR ulcer and develop to benign protruding lesions. And, H. pylori and PPI might also be related to the development of the protruding lesions.

Long-term Follow-up Results of Endoscopic Mucosal Resection for Early Gastric Cancer and Gastric Flat Adenoma / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic mucosal resection (EMR) of early gastric cancer (EGC) or gastric flat adenoma has been widely accepted as a useful method due to its minimal invasiveness and satisfactory post- procedure results in maintaining a good quality of life for patients. The purpose is to define the long-term effect and usefulness of EMR of EGC and gastric flat adenoma. METHODS: We analysed, retrospectively, 101 lesions in 96 cases that could be followed-up were analyzed. Endoscopic surveillance with histological examination was carried out every three months for one year after the treatment, every six months for the second year, and annually thereafter. RESULTS: 1) The mean follow-up period was 17.7 months (1-78). 2) Of the 101 lesions, there were 6 recurrences (5.9%), the mean period was 17.3 months (2-37). One of 28 EGC, five of 73 gastric flat adenoma showed recurrence. 3) The recurrence rate tended to be higher in as the size increased (p=0.06). In the lesions which were resected by planned piecemeal, 10% of those lesions recurred (4/40), while 3.3% (2/61) of those lesions recurred in which lesions were resected en bloc (p=0.21). 4) With respect to location of the primary lesions, the recurrence rate was higher in the lesions of the cardia (50%, p<0.05). CONCLUSIONS: We concluded that the size and location of the lesions were related to recurrence after EMR, but sex, pathology, and resection methods were not related.