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Kwon, Park, Yun, Noh, Yoon, Chang, Oh, Kim, Lee, Joo, Lee, Kim, Yeon, Kim, Byun, and Bak: Clinicopathologic Features of Cases with Negative Pathologic Results after Endoscopic Submucosal Dissection
Original Article
Alimentary Tract
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(3): 211-217.

Published online: 21 March 2012

DOI: https://doi.org/10.4166/kjg.2012.59.3.211

Clinicopathologic Features of Cases with Negative Pathologic Results after Endoscopic Submucosal Dissection

Min-Jung Kwon, Jong-Jae Park, Jae-Won Yun, Hye Jin Noh, Dae Woong Yoon, Won Jin Chang, Ha Young Oh, Baek-Hui Kim1, Hyunjoo Lee2, Moon Kyung Joo, Beom Jae Lee, Ji Hoon Kim, Jong Eun Yeon, Jae Seon Kim, Kwan Soo Byun, Young-Tae Bak

Division of Gastroenterology, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, Seoul, Korea.

1Department of Pathology, Guro Hospital, Korea University College of Medicine, Seoul, Korea.

2Department of Pathology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea.

Correspondence to: Jong-Jae Park, Division of Gastroenterology, Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, 148 Gurodongro, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3003, Fax: +82-2-2626-1038, gi7pjj@yahoo.co.kr

Received 16 September 2011       Revised 6 October 2011       Accepted 7 October 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Endoscopic submucosal dissection (ESD) is accepted as a standard treatment of early gastric cancer (EGC) and gastric adenoma. Occasionally, tumorous lesion is not found and pathologic discrepancies can occur after ESD. The aim of this study was to analyze the factors affecting the negative pathologic results after ESD.

Methods

We retrospectively reviewed the data from all patients with gastric neoplasm (276 EGC and 516 gastric adenomas) who were treated with ESD during past 3 years and enrolled the patients who had negative pathologic results.

Results

Out of 792 patients treated with ESD, 27 patients (3.4%) were eligible for inclusion. Among the 27 patients, factors affecting the negative pathologic results were, most commonly, the focal lesion (n=13, 48.2%) which was small enough to be removed completely during pre-ESD biopsy, followed by pathologic discrepancies (n=11, 40.7%) between pathologists and lastly the operator factor (n=3, 11.1%) dissecting incorrect lesions. Of the focal lesions, the initial pathologic diagnoses were adenocarcinoma in 11 cases (84.6%). In cases with pathologic discrepancies, all the pretreatment diagnoses were adenoma with low grade dysplasia. In cases caused by operator factors, intestinal metaplasia was accompanied by elevated adenoma in all cases.

Conclusions

To decrease negative pathologic results after ESD, an endoscopist should perform ESD after sufficient communication with pathologists, especially for adenoma with low grade dysplasia, and choose correct lesion, especially located at the antrum and associated with intestinal metaplasia. The possibility of total removal of small lesions even by forcep biopsy should be considered.

Keywords: Endoscopic submucosal dissection, Negative pathologic results, Early gastric cancer, Gastric adenoma

Figures and Tables

Fig. 1
Baseline pathologic findings before endoscopic submucosal dissection.
EGC, early gastric cancer; LGD, low grade dysplasia; HGD, high grade dysplasia.
aNo tumorous tissue was found.
kjg-59-211-g001
Table 1
Baseline Characteristics of Cases with Negative Pathologic Results after ESD
kjg-59-211-i001

ESD, endoscopic submucosal dissection; M, male; F, female.

Table 2
Clinicopathologic Characteristics of Cases with Negative Pathologic Results after ESD according to the Causative Factors
kjg-59-211-i002

ESD, endoscopic submucosal dissection; M, male; F, female; HGD, high grade dysplasia; LGD, low grade dysplasia.

aComparison among three groups, bcomparison in each group in terms of variables.

Table 3
Clinicopathologic Characteristics of Cases with Negative Pathologic Results after ESD due to Operator Factor
kjg-59-211-i003

ESD, endoscopic submucosal dissection; M, male; F, female; HGD, high grade dysplasia; LGD, low grade dysplasia; IM, intestinal metaplasia.

Notes

Financial support: None.

Conflict of interest: None.

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