Clin Endosc.  2016 Jul;49(4):332-335. 10.5946/ce.2016.069.

Treatment Strategy after Incomplete Endoscopic Resection of Early Gastric Cancer

• Kim SG

• KMID: 2348250
• DOI: http://doi.org/10.5946/ce.2016.069

Abstract

Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For inoperable patients, argon plasma coagulation can be used as an alternative endoscopic treatment. Immediately after the incomplete resection or residual tumor has been confirmed by the pathologist, clinicians should also decide upon any additional treatment to be carried out during the follow-up period.

Keyword

Therapeutics; Incomplete resection; Endoscopic submucosal dissection; Early gastric cancer

MeSH Terms

Argon Plasma Coagulation
Cautery
Follow-Up Studies
Humans
Neoplasm, Residual
Stomach Neoplasms*

Figure

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  Fig. 1. Additional endoscopic submucosal dissection (ESD) to treat residual tumor during follow-up. (A) Residual tumor during follow-up after incomplete ESD. (B) Additional ESD for residual tumor, which may be technically difficult due to extensive submucosal fibrosis.

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  Fig. 2. Additional argon plasma coagulation (APC) to treat residual tumor during follow-up. (A) Residual tumor during follow-up after incomplete endoscopic submucosal dissection. (B) Additional APC for residual tumor. (C) Post-coagulation state. (D) No residual tumor during follow-up.

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