Abstract:
BACKGROUND:Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) after surgical gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach as well as the presence of severe gastric fibrosis and staples under the suture line. OBJECTIVE:We evaluated clinical results including long-term outcomes to determine the feasibility and effectiveness of ESD for EGC in the remnant stomach of patients after gastrectomy. DESIGN:Retrospective study. SETTING:National Cancer Center Hospital, Tokyo, Japan. PATIENTS:We investigated patients undergoing ESD for EGC in the remnant stomach from 1997 to 2011. INTERVENTION ESD MAIN OUTCOME MEASUREMENTS:We examined the patient characteristics, endoscopic findings, technical results, adverse events, and histopathologic results including curability and evaluations of Helicobacter pylori gastritis in addition to the rates of local recurrence, metachronous gastric cancer, overall survival, and cause-specific survival. RESULTS:A total of 128 consecutive patients with 139 lesions had previously undergone 87 distal (68%), 25 proximal (19.5%) and 16 pylorus-preserving gastrectomies (12.5%). The median period from the original gastrectomy to the subsequent ESD for EGC in the remnant stomach was 5.7 years (range 0.6-51 years), the median tumor size was 13 mm (range 1-60 mm), and the median procedure time was 60 minutes (range 15-310 minutes). There were 131 en bloc resections (94%), with curative resections achieved for 109 lesions (78%); 22 lesions (16%) resulted in non-curative resections, and 8 lesions (6%) had only a horizontal margin positive or had inconclusive results. A total of 118 patients (92%) were assessed as H pylori gastritis-positive, with 7 patients (5%) negative. Adverse events included 2 cases of delayed bleeding (1.4%) and 2 perforations (1.4%), with 1 patient requiring emergency surgery. The 5-year overall and cause-specific survival rates were 87.3% and 100%, respectively, during a median follow-up period of 4.5 years (range 0-13.7 years), with no deaths from EGC in the remnant stomach. LIMITATIONS:Single-center, retrospective study. CONCLUSION:ESD for EGC in the remnant stomach of patients after gastrectomy was a feasible and effective therapeutic method and should become the standard treatment in such cases, based on the favorable long-term outcomes.
journal_name
Gastrointest Endoscjournal_title
Gastrointestinal endoscopyauthors
Nonaka S,Oda I,Makazu M,Haruyama S,Abe S,Suzuki H,Yoshinaga S,Nakajima T,Kushima R,Saito Ydoi
10.1016/j.gie.2013.02.006subject
Has Abstractpub_date
2013-07-01 00:00:00pages
63-72issue
1eissn
0016-5107issn
1097-6779pii
S0016-5107(13)00110-7journal_volume
78pub_type
杂志文章abstract:BACKGROUND:Initial clinical applications have shown that US elastography might be able to distinguish tissues because of their specific consistency. OBJECTIVE:(1) To investigate the feasibility of EUS elastography of the pancreas and (2) to describe elastographic patterns of the normal pancreas and the pancreas affect...
journal_title:Gastrointestinal endoscopy
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abstract::Bacteriologic studies of bile and blood cultures of 579 patients with ductal stones and infected bile revealed that 121 patients (21%) had associated bacteremia. Analysis of bile and stone cultures showed that Escherichia coli, Klebsiella sp, Enterobacter sp, Enterococcus sp, and Streptococcus sp were the most commonl...
journal_title:Gastrointestinal endoscopy
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abstract:BACKGROUND:Diverticulotomy is a standard treatment for Zenker's diverticulum (ZD). This technique was adapted to flexible endoscopy. OBJECTIVE:We report our long-term results of ZD treatment by using flexible endoscopy assisted by a soft diverticuloscope. DESIGN:Follow-up study. SETTING:Academic hospital. Tertiary-c...
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2007.11.040
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章,多中心研究
doi:10.1016/j.gie.2007.01.017
更新日期:2007-08-01 00:00:00
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
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更新日期:2011-11-01 00:00:00
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章,多中心研究
doi:10.1016/j.gie.2008.08.041
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章,多中心研究
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journal_title:Gastrointestinal endoscopy
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journal_title:Gastrointestinal endoscopy
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
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journal_title:Gastrointestinal endoscopy
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pub_type: 杂志文章,随机对照试验
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