Korean J Gastroenterol.  2014 Aug;64(2):76-80. 10.4166/kjg.2014.64.2.76.

Optimal Timing of Endoscopic Clipping for Determining the Resection Line for Laparoscopy-assisted Distal Gastrectomy

• Park JY
• Jeon TJ
• Shin WC

• KMID: 2164416
• DOI: http://doi.org/10.4166/kjg.2014.64.2.76

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).
CONCLUSIONS
The timing of endoscopic clipping for localization of tumors in early gastric cancer patients undergoing gastrectomy is not important for determining the resection line.

Keyword

Stomach cancer; Laparoscopic surgery; Endoscopic clip; Gastrectomy

MeSH Terms

Aged
Female
Gastrectomy/*methods
Humans
*Laparoscopy
Male
Middle Aged
Neoplasm Staging
Preoperative Care
Radiography, Abdominal
Retrospective Studies
Stomach Neoplasms/pathology/*surgery
Surgical Instruments
Time Factors

Figure

• 

  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).

Reference

References

1. Hyung WJ, Lim JS, Cheong JH, et al. Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-as-sisted gastrectomy. Surg Endosc. 2005; 19:1353–1357.

2. Ryu KW, Lee JH, Choi IJ, Bae JM. Preoperative endoscopic clipping: localizing technique of early gastric cancer. J Surg Oncol. 2003; 82:75–77.

3. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg. 1999; 230:170–178.

4. Kikuchi S, Hirai K, Kuroyama S, et al. Role of endoscopic clipping for determining the resection line for tumors located in the middle or upper corpus of the stomach: experience with 100 gastrectomies for early gastric cancer. Anticancer Res. 2004; 24:4163–4168.

5. Beretvas RI, Ponsky J. Endoscopic marking: an adjunct to laparoscopic gastrointestinal surgery. Surg Endosc. 2001; 15:1202–1203.

6. Cipolletta L, Bianco MA, Rotondano G, Marmo R, Piscopo R, Meucci C. Endoscopic clipping of perforation following pneu-matic dilation of esophagojejunal anastomotic strictures. Endoscopy. 2000; 32:720–722.

7. Weyman RL, Rao SS. A novel clinical application for endoscopic mucosal clipping. Gastrointest Endosc. 1999; 49:522–524.

8. Kuwano H, Sadanaga N, Watanabe M, et al. Preoperative endoscopic clipping for determining the resection line in early carcinoma of the esophagus. J Am Coll Surg. 1995; 180:97–99.

9. Okabayashi T, Gotoda T, Kondo H, et al. Usefulness of indigo carmine chromoendoscopy and endoscopic clipping for accurate preoperative assessment of proximal gastric cancer. Endoscopy. 2000; 32:S62.

10. Lee SE, Kim YW, Lee JH, et al. Developing an institutional protocol guideline for laparoscopy-assisted distal gastrectomy. Ann Surg Oncol. 2009; 16:2231–2236.

11. Kim YW, Baik YH, Yun YH, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008; 248:721–727.

12. Ohgami M, Otani Y, Kumai K, Kubota T, Kim YI, Kitajima M. Curative laparoscopic surgery for early gastric cancer: five years experience. World J Surg. 1999; 23:187–192. discussion 192–193.