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Abstract
Background/Aims
Pre-operative endoscopic clipping for determining the resection line in patients with early gastric cancer has been used safely, and its efficacy has been demonstrated. However, the optimal timing of endoscopic clipping for determining the resection line in early gastric cancer patients undergoing laparoscopy-assisted distal gastrectomy has not been investigated.
Methods
A retrospective analysis of 92 patients with early gastric cancer who underwent gastric resection after endoscopic clipping at Inje University Sanggye Paik Hospital (Seoul, Korea) was performed. We analyzed the clinical and endoscopic features of patients, number of clips, time from clipping to surgery, and number of patients showing detachment of clips from the gastric wall before surgery. Patients were categorized according to the following two groups: group A included patients whose clips were applied within one day before surgery and group B included patients whose clips were applied more than one day before surgery.
Results
Of the 92 patients, 56 were included in group A and 36 were included in group B. In 11 patients (12.0%, five in group A and six in group B, p=0.329), the clips were detached from the gastric wall before surgery. The mean time from clipping to surgery did not differ significantly between the detached and non-detached groups (11 patients, mean 4.6±4.6 days vs. 81 patients, mean 3.0±4.0 days, p=0.227).
References
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Fig. 1.
Pre-operative endoscopic clipping for early gastric cancer (HX-600–090LⓇ; Olympus). Pre-operative application of a clip at the proximal side of the lesion (A) and plain abdominal x-rays obtained after clipping in the upright position (circle; B).
Fig. 2.
Resected specimen of early gastric cancer marked with a preoperative endoscopic clip (arrow).
Table 1.
Clinical and Endoscopic Features of the 92 Patients Who Underwent Endoscopic Clipping for Early Gastric Cancer
| Group A (≤1 day, n=56) | Group B (＞1 day, n=36) | p-value a | |
|---|---|---|---|
| Age (yr) | 61.8±10.4 | 61.3±10.7 | 0.819 |
| Sex (male: female) | 43 (76.8): 13 (23.2) | 19 (52.8): 17 (47.2) | 0.017 |
| Location | 0.256 | ||
| Antrum | 31 (55.4) | 13 (36.1) | |
| Angle | 11 (19.6) | 8 (22.2) | |
| Lower body | 11 (19.6) | 13 (36.1) | |
| Middle body | 3 (5.4) | 2 (5.6) | |
| Number of clips | 3.1±0.8 | 3.1±1.0 | 0.941 |
| Loss of clips (patient, n) | 5 (8.9) | 6 (16.7) | 0.329 |
Table 2.
Clinical and Endoscopic Features of 11 Patients Who Showed Detachment of Clips Applied for Determining the Resection Line before Surgery
| Detached (n=11, 12.0%) | Non‐ detached (n=81, 88.0%) | p‐ value a | |
|---|---|---|---|
| Age (yr) | 65.4±9.0 | 61.1±10.6 | 0.202 |
| Sex (male: female) | 8 (72.7): 3 (27.3) | 54 (66.7): 27 (33.3) | 0.687 |
| Location | 0.187 | ||
| Antrum | 8 (72.7) | 36 (44.4) | |
| Angle | 0 (0) | 19 (23.5) | |
| Lower body | 2 (18.2) | 22 (27.2) | |
| Middle body | 1 (9.1) | 4 (4.9) | |
| Number of clips | 3.1±0.8 | 3.0±1.1 | 0.632 |
| Time‐ to‐ surgery (day) | 4.6±4.6 | 3.0±4.0 | 0.227 |
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