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How can we predict the presence of missed synchronous lesions after endoscopic submucosal dissection for early gastric cancers or gastric adenomas?

Authors
Yoo, JH; Shin, SJ; Lee, KM; Choi, JM; Wi, JO; Kim, DH; Lim, SG; Hwang, JC; Cheong, JY; Yoo, BM; Lee, KJ; Kim, JH; Cho, SW
Citation
Journal of clinical gastroenterology, 47(2):e17-e22, 2013
Journal Title
Journal of clinical gastroenterology
ISSN
0192-07901539-2031
Abstract
GOALS: To identify predictive factors associated with the presence of missed synchronous lesions after endoscopic submucosal dissection (ESD) for gastric adenoma or early gastric cancer (EGC).



BACKGROUND: Secondary gastric neoplasms that develop during follow-up period after ESD for gastric adenoma or EGC are divided into metachronous lesions and missed synchronous lesions.



METHODS: ESD was performed in 250 patients with EGC or gastric adenoma. The patients with endoscopic follow-ups of <1 year, patients without curative resection, and patients with additional surgery were excluded from the study. Missed synchronous lesions were defined as secondary gastric neoplasms detected within one year of ESD but initially missed. We compared clinicopathologic factors between patients with missed synchronous lesions and patients without missed synchronous lesions.



RESULTS: Missed synchronous lesions were found in 11.6% of the patients (29/250). The occurrence of missed synchronous lesions had significant correlation with tumor number at the time of ESD and age in the univariate analysis. Tumor number at the time of ESD and age were significant independent predictive factors for presence of missed synchronous lesions by multivariate logistic regression analysis (odds ratio 5.302, P = 0.006; odds ratio 2.315, P = 0.040, respectively). Missed synchronous lesions tended to be smaller, often located in the same third of the stomach as the main lesions.



CONCLUSIONS: Tumor number at the time of ESD and age could be predictive factors for the presence of missed synchronous lesions after ESD. Careful endoscopic surveillance should be performed after ESD for multiple lesions or for elderly patients.
MeSH terms
Adenoma/epidemiology/pathology/*surgeryAge FactorsAgedBiopsyChi-Square Distribution*Diagnostic ErrorsEarly Detection of CancerFemaleGastric Mucosa/pathology/*surgery*GastroscopyHumansIncidenceKaplan-Meier EstimateLogistic ModelsMaleMiddle AgedMultivariate AnalysisNeoplasms, Multiple Primary/epidemiology/pathology/*surgeryOdds RatioPredictive Value of TestsRepublic of Korea/epidemiologyRetrospective StudiesRisk FactorsStomach Neoplasms/epidemiology/pathology/*surgeryTime FactorsTreatment Outcome
DOI
10.1097/MCG.0b013e31825c0b69
PMID
22810109
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
AJOU Authors
유, 준환신, 성재이, 기명김, 동훈임, 선교황, 재철정, 재연유, 병무이, 광재김, 진홍조, 성원
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