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Underestimation of endoscopic size in large gastric epithelial neoplasms
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Jae Sun Song, Byung Sun Kim, Min A Yang, Young Jae Lee, Gum Mo Jung, Ji Woong Kim, Jin Woong Cho
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Clin Endosc 2022;55(6):760-766. Published online May 19, 2022
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DOI: https://doi.org/10.5946/ce.2021.269
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Abstract
PDFPubReaderePub
- Background
/Aims: Endoscopic submucosal dissection (ESD) is an effective method for resecting gastric adenomas and adenocarcinomas. A significant discrepancy was observed between endoscopic and pathological sizes in samples obtained from patients undergoing ESD. This study elucidates the factors affecting size discrepancy after formalin fixation.
Methods The records of 64 patients with 69 lesions were analyzed, including 50 adenomas and 19 adenocarcinomas. Data on location, gross shape, histology, and size after fixation in formalin were collected.
Results The mean size of the resected specimen appeared to decrease after formalin fixation (37.5 mm prefixation vs. 35.8 mm postfixation, p<0.05). The mean long axis diameter of the lesions was 20.3±7.9 mm prefixation and 13.4±7.9 mm postfixation. Size differences in lesions smaller than 20 mm were significantly greater than those in lesions larger than 20 mm (7.6±5.6 mm vs. 2.5±5.8 mm, p<0.01). In multivariate analysis, a tumor size of ≥20 mm was found to be an independent factor affecting size postformalin fixation (p<0.05).
Conclusions The endoscopic size of lesions before ESD may be underestimated in tumors larger than 20 mm in size. Therefore, increased attention must be paid during ESD to avoid instances of incomplete resection.
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Citations
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- Transcecal endoscopic appendectomy for management of complex appendiceal polyps extending into the appendiceal orifice
Tara Keihanian, Mai A Khalaf, Fuad Zain Aloor, Dina Hani Zamil, Salmaan Jawaid, Mohamed O. Othman Endoscopy International Open.2024; 12(08): E932. CrossRef
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An Intractable Caustic Esophageal Stricture Successfully Managed with Sequential Treatment Comprising Incision with an Insulated-Tip Knife, Balloon Dilation, and an Oral Steroid
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Woong Ki Lee, Byung Sun Kim, Min A Yang, So Hee Yun, Young Jae Lee, Ji Woong Kim, Jin Woong Cho
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Clin Endosc 2016;49(6):560-563. Published online August 12, 2016
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DOI: https://doi.org/10.5946/ce.2016.048
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Abstract
PDFPubReaderePub
- Bougie or balloon dilation is a good short-term treatment for caustic esophageal strictures, although recurrence after dilation occurs in approximately 30% of these cases. Therefore, long-term treatment options are required in some cases, and endoscopic incisional therapy has been used for patients with an anastomotic stricture in the gastrointestinal tract. A 58-year-old woman presented with severe swallowing difficulty because of a caustic esophageal stricture, which was caused by accidental exposure to anhydrous acetic acid at infancy. She had undergone several previous bougie and balloon dilations but the stricture did not improve. We performed sequential treatment comprising incision with an insulated-tip knife, balloon dilation, and an oral steroid, which resulted in the patient’s symptoms markedly improving. Thus, we report this case of an intractable caustic esophageal stricture, which was successfully treated using combined endoscopic sequential treatment.
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Citations
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- A new simple endoscopic incision therapy for refractory benign oesophageal anastomotic stricture
Jeongmin Choi, Soo In Choi BMJ Case Reports.2021; 14(3): e239798. CrossRef - Endoscopic incision for treatment of benign gastrointestinal strictures
Chengbai Liang, Yuyong Tan, Jiaxi Lu, Meixian Le, Deliang Liu Expert Review of Gastroenterology & Hepatology.2020; 14(6): 445. CrossRef
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