• Early gastric cancer
• Endoscopic resection
• Gastric low-grade intraepithelial neoplasia
• Pathological upgrade
• Prediction model

• Humans
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Stomach Neoplasms/diagnosis
• Retrospective Studies
• Female
• Middle Aged
• Male
• Carcinoma in Situ/pathology
• Carcinoma in Situ/surgery
• Carcinoma in Situ/diagnosis
• Gastroscopy
• Risk Assessment/methods
• Aged
• Neoplasm Grading
• Biopsy
• Disease Progression
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastric Mucosa/diagnostic imaging
• Adult
• Logistic Models
• Endoscopic Mucosal Resection
• Predictive Value of Tests
• China
• Sensitivity and Specificity
• Risk Factors

• Gastric cancer
• Low-grade intraepithelial neoplasia
• Progression
• Prospective study
• Risk factor

• ESD, endoscopic submucosal dissection

• Humans
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Retrospective Studies
• Endoscopic Mucosal Resection/methods
• Biopsy/methods
• Adenocarcinoma/diagnosis
• Adenocarcinoma/surgery
• Adenocarcinoma/pathology

• Adenoma
• EMR with circumferential precutting (EMR-P)
• Endoscopic submucosal dissection (ESD)
• Stomach

• esophageal squamous low-grade intraepithelial neoplasms
• histological upgrade
• superficial esophageal squamous dysplasia

• endoscopic submucosal dissection
• gastric peroral endoscopic myotomy
• stenosis

To date, there exists no established endoscopic surveillance interval strategy after endoscopic submucosal dissection (ESD) for gastric adenoma. In this study, we suggest a risk factor-based statistical model for optimal surveillance intervals for gastric adenoma after ESD with curative resection. A cox proportional hazard model was applied to identify risk factors for recurrence after ESD. Patients (n = 698) were categorized into groups based on the identified risk factors. The cumulative density of recurrence over time was computed using a cubic splined baseline hazard function, and the customized surveillance interval was modeled for each risk group. The overall cumulative incidence of recurrence was 7.3% (n = 51). Risk factors associated with recurrence were male (hazard ratio [HR], 2.60, P = 0.030), protruded scar (HR, 3.18, P < 0.001), and age ≥ 59 years (HR, 1.05, P < 0.001). The surveillance interval for each group was developed by using the recurrence limit for the generated risk groups. According to the developed schedule, high-risk patients would have a maximum of seven surveillance visits for 5 years, whereas low-risk patients would have biennial surveillance for cancer screening. We proposed a simple and promising strategy for determining a better endoscopic surveillance interval by parameterizing diverse and group-specific recurrence risk factors into a well-known survival model.

• Dysplasia
• EGC
• Endoscopic resection
• Stomach cancer

• Endoscopic Mucosal Resection/adverse effects
• Gastric Mucosa/surgery
• Humans
• Neoplasm Recurrence, Local
• Retrospective Studies
• Stomach Neoplasms/surgery
• Treatment Outcome

• Early gastric cancer
• Low-grade intraepithelial neoplasia (LGIN)
• Risk model

• Carcinoma in Situ/diagnosis
• Carcinoma in Situ/pathology
• Disease Progression
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Validation Studies as Topic

• No.81770561 and No.81970499 National Natural Science Foundation of China (CN)
• CXTDA2017033 Jiangsu medical leading talent and innovation team
• BRA2014332 Jiangsu Province "333"project
• BE2015716 Jiangsu Standard Diagnosis and Treatment Research for Key Disease

Some cases of gastric low-grade dysplasia (LGD) and high-grade dysplasia (HGD) on forceps biopsy (FB) are diagnosed as gastric cancer (GC) after endoscopic resection (ER). This study aims to evaluate the clinical outcomes of ER for gastric LGD and HGD on pretreatment FB and to identify the factors that predict pathologic upstaging to GC.

Patients who underwent ER for LGD and HGD on pretreatment FB from March 2005 to February 2018 in 14 hospitals in South Korea were enrolled, and the patients’ medical records were reviewed retrospectively.

This study included 2,150 cases of LGD and 1,534 cases of HGD diagnosed by pretreatment FB. In total, 589 of 2,150 LGDs (27.4%) were diagnosed as GC after ER. Helicobacterpylori infection, smoking history, tumor location in the lower third of the stomach, tumor size >10 mm, depressed lesion, and ulceration significantly predicted GC. A total of 1,115 out of 1,534 HGDs (72.7%) were diagnosed with GC after ER. Previous history of GC, H. pylori infection, smoking history, tumor location in the lower third of the stomach, tumor size >10 mm, depressed lesion, and ulceration were significantly associated with GC. As the number of risk factors predicting GC increased in both LGD and HGD on pretreatment FB, the rate of upstaging to GC after ER increased.

A substantial proportion of LGDs and HGDs on pretreatment FB were diagnosed as GC after ER. Accurate ER procedures such as endoscopic submucosal dissection should be recommended in cases of LGD and HGD with factors predicting pathologic upstaging to GC.

• Endoscopic resection
• Gastric cancer
• High-grade dysplasia
• Low-grade dysplasia
• Risk factors

• Chronic gastritis
• Cribado poblacional
• Cáncer gástrico
• Cáncer gástrico familiar
• Displasia
• Dysplasia
• Familial gastric cancer
• Gastric cancer
• Gastritis crónica
• Helicobacter pylori
• Intestinal metaplasia
• Mass screening
• Metaplasia intestinal

Recurrence risk is a major concern after endoscopic resection (ER) of gastric neoplasms. This study was to compare metachronous risk in patients with and without synchronous neoplasms after complete ER.

After ER for gastric neoplasms, patients were divided into those with and without synchronous neoplasm. The metachronous risk of gastric neoplasms was compared between the two groups.

After ER of 678 cancers and 891 adenomas, synchronous neoplasm was found in 11.8% of cancers and 11.4% of adenomas. In the multiple (n = 182) and the single group (n = 1387), metachronous neoplasms occurred in 18.1 and 8.6%, respectively (HR 2.40; 95% CI, 1.62–3.34). When the pathology of the recurred lesion was limited to cancer, metachronous risk was also significantly higher in the multiple than in the single group (HR, 2.2; 95% CI, 1.17–3.85). In the recurred pathology of the multiple group, cancer development was frequently observed in patients with cancer compared to those with only adenomas in the synchronous lesion (67.0% vs. 13.0%, respectively; P = 0.023).

This study demonstrated that metachronous risk was significantly higher in patients with synchronous gastric neoplasms after ER. Therefore, meticulous examination is important in patients with synchronous neoplasm.

• Endoscopic mucosal resection
• Endoscopy
• Recurrence
• Stomach neoplasms

• endoscopic submucosal dissection
• gastric neoplasm
• intestinal metaplasia
• lesion size
• recurrence
• risk factors

• Adenoma/classification
• Adenoma/surgery
• Aged
• Endoscopic Mucosal Resection/methods
• Female
• Follow-Up Studies
• Humans
• Incidence
• Intestines/pathology
• Male
• Metaplasia
• Middle Aged
• Recurrence
• Republic of Korea/epidemiology
• Retrospective Studies
• Risk Factors
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

• computed tomgraphy
• early gastric cancer
• lymph node metastasis
• submucosal invasion

• Aged
• Cross-Sectional Studies
• Decision Making
• Feasibility Studies
• Female
• Humans
• Lymphatic Metastasis/diagnostic imaging
• Male
• Middle Aged
• Neoplasm Invasiveness/diagnostic imaging
• Neoplasm Staging/methods
• Preoperative Period
• Retrospective Studies
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Tomography, X-Ray Computed/methods

• endoscopy: upper GI
• esophageal neoplasms
• esophagus

• Aged
• Aged, 80 and over
• Biopsy/instrumentation
• Biopsy/methods
• Carcinoma in Situ/diagnosis
• Carcinoma in Situ/pathology
• Carcinoma in Situ/surgery
• Carcinoma, Squamous Cell/diagnosis
• Carcinoma, Squamous Cell/pathology
• Carcinoma, Squamous Cell/surgery
• Diagnosis, Differential
• Endoscopy, Gastrointestinal/instrumentation
• Endoscopy, Gastrointestinal/methods
• Esophageal Neoplasms/diagnosis
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/surgery
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Specimen Handling/instrumentation
• Specimen Handling/methods
• Surgical Instruments

• Busan Cancer Center Research Grant

• curative resection
• eCura system
• early gastric cancer
• endoscopy
• gastric neoplasms
• surveillance

• Biopsy
• Endoscopic submucosal dissection
• Gastric cancer
• Neoplasia

Post-endoscopic submucosal dissection bleeding (PEB) is one of the important complications after endoscopic submucosal dissection (ESD), but still difficult to predict. The present study aimed to identify significant risk factors for PEB according to onset time. Between November 2008 and January 2016, a total of 1864 lesions resected via ESD were analyzed. PEB was classified as either early or late according to onset time (within or after 24 hours post-ESD, respectively). During second-look endoscopy, the artificial ulcer bed was subjected to Forrest classification. A high risk of stigma was defined as active spurting bleeding, oozing bleeding, and a non-bleeding visible vessel in the ulcer. The endoscopic factors and medications associated with PEB were analyzed. PEB occurred in 77 lesions (4.1%): early only in 46 (2.4%), late only in 22 (1.1%), and early and late in 9 (0.4%). Among 55 early PEB events, 25 were asymptomatic and diagnosed during second-look endoscopy. Age ≤65 years, resection size ≥30 mm, procedure time ≥20 min, lower third of the stomach, erosion, and clopidogrel use were significantly associated with early PEB. If the number of risk factors were ≤1, the risk of early PEB was 0.6%. For late PEB, the mid to upper third of the stomach, undifferentiated carcinoma, erosion, high risk of stigma during second-look endoscopy, history of early PEB, and clopidogrel use were significant risk factors. If risk factors were absent, the risk of late PEB was 0.1%. For patients at high risk of early PEB, selective second-look endoscopy might be a useful. For patients at high risk of late PEB, careful monitoring of bleeding should be considered.

• endoscopic resection
• low-grade dysplasia
• magnifying endoscopy
• narrow band imaging
• precancerous lesion
• stomach neoplasms

• biopsy
• dysplasia
• early gastric cancer
• endoscopic submucosal dissection

• Aged
• Biopsy/methods
• Diagnostic Errors/statistics & numerical data
• Dissection/methods
• Early Detection of Cancer/methods
• Endoscopic Mucosal Resection/methods
• Female
• Gastric Mucosa/pathology
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Neoplasms, Glandular and Epithelial/pathology
• Retrospective Studies
• Risk Factors
• Stomach/pathology
• Stomach/surgery
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

• Curative resection
• En bloc resection
• Perforation
• R0 resection

• Endoscopic Mucosal Resection/adverse effects
• Esophageal Mucosa/pathology
• Esophageal Mucosa/surgery
• Gastric Mucosa/pathology
• Gastric Mucosa/surgery
• Gastrointestinal Neoplasms/pathology
• Gastrointestinal Neoplasms/surgery
• Humans
• Intestinal Mucosa/pathology
• Intestinal Mucosa/surgery
• Neoplasm Recurrence, Local/epidemiology
• Neoplasm Recurrence, Local/prevention & control
• Operative Time
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Treatment Outcome

We aimed to investigate whether the current indications for curative endoscopic resection (ER) of gastric cancer (GC) can be applied to GC caused by adenoma. Additionally, we attempted to identify factors predictive of lesions subsequently found in addition to the expanded indications for ER.

We retrospectively analyzed 342 patients diagnosed with GC caused by adenoma who underwent ER at a single tertiary center between February 2011 and December 2014. The gross whole tumor size was measured using the endoscopically resected specimen. The microscopic whole tumor size was measured using mapping paper. The estimated cancer size was calculated using the microscopic whole tumor size and the square root of the carcinoma component.

A gross whole tumor size ≥3 cm, carcinoma component ≥35%, and gross ulceration were predictive of lesions other than the expanded indications for ER. The overall rate of lymph node metastasis was 0.3% (1/327), which only occurred in one patient with a lesion other than the expanded indications (4.5%, 1/22).

The current indications for curative ER in GC can be applied to GC caused by adenoma. In cases suspected of having lesions other than the expanded indications, patients should be cautiously selected for ER to reduce the risk of an inappropriate procedure.

• Adenocarcinoma
• Adenoma
• Endoscopy
• Upper gastrointestinal track

Endoscopic submucosal dissection (ESD) has been widely accepted as a method of treatment of early gastric tumor. This study aimed to identify the incidence and characteristics of multiple gastric tumors after ESD.

Patients with early gastric tumors who were treated by ESD from January 2004 to June 2012 and followed up with endoscopic examination periodically for at least 1 year were enrolled. All multiple gastric lesions were subsequently treated with ESD and the medical records of the patients were retrospectively reviewed.

In total, 643 patients were included. The mean duration of endoscopic follow-up was 45.27±27.59 (range, 12–148) months. Overall, 144 patients (22.4%) showed multiple gastric tumors during the follow-up period (44 synchronous [6.8%] and 100 metachronous [15.5%]). The cumulative incidence rate steadily increased during the follow-up period. More than 50% of the tumors that developed at the same longitudinal location of the stomach were of the same macroscopic and histological type as the primary lesions.

Because synchronous and/or metachronous gastric tumors are common, considerable attention should be paid to detect multiple gastric lesions after ESD of early gastric neoplasm.

• Endoscopic submucosal dissection
• Neoplasms, second primary
• Stomach neoplasms

• Dysplasia
• Endoscopic treatment
• Gastric adenoma

• Adenoma/pathology
• Adenoma/surgery
• Argon Plasma Coagulation
• Endoscopic Mucosal Resection
• Humans
• Precancerous Conditions/surgery
• Remission Induction
• Stomach/pathology

• Biopsy
• Dysplasia
• Early gastric cancer
• Endoscopic submucosal dissection

• Fundic gland adenoma
• colon adenoma
• diminutive colon polyps
• duodenal adenoma
• endoscopic mucosal resection (EMR)
• endoscopic submucosal dissection (ESD)
• gastric adenoma
• snare polypectomy

• Adenocarcinoma/epidemiology
• Adenocarcinoma/pathology
• Adenoma/pathology
• Adenoma/surgery
• Aged
• Carcinoma, Signet Ring Cell/epidemiology
• Carcinoma, Signet Ring Cell/pathology
• Endoscopic Mucosal Resection
• Female
• Gastric Mucosa/surgery
• Helicobacter Infections/epidemiology
• Humans
• Incidence
• Male
• Middle Aged
• Neoplasm Staging
• Neoplasms, Second Primary/epidemiology
• Neoplasms, Second Primary/pathology
• Retrospective Studies
• Stomach Neoplasms/epidemiology
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery

AIM: To evaluate the diagnostic performance of narrow-band imaging combined with magnifying endoscopy (NBI-ME) for early gastric cancer by comparing with gastric biopsy.

METHODS: Patients with suspicious early gastric lesions (including abnormal mucosal morphology and abnormal mucosal color) as revealed by white light endoscopy (WLE) were enrolled in the study. These suspicious lesions were examined by NBI-ME to give a diagnosis. Biopsy specimens were then taken from suspicious lesions for pathological examination. All patients received endoscopic resection or surgical intervention. The diagnostic performance of the two modalities was compared.

RESULTS: A total of 123 patients were enrolled, including 76 men and 47 women. The final pathology showed 51 cases of gastritis, 24 cases of low grade intraepithelial neoplasia, and 48 cases of early gastric cancer. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of NBI-ME for diagnosing early gastric cancer were 97.9%, 80.0%, 75.8%, 98.4%, and 87.0%, respectively; the corresponding percentages for endoscopic biopsy were 66.7%, 94.7%, 88.9%, 81.6%, and 83.7%, respectively. The sensitivity of NBI-ME was significantly better than that of endoscopic biopsy (P < 0.005), but specificity was lower than that of endoscopic biopsy (P < 0.005). There was no statistical difference in diagnostic accuracy between the two modalities. The Kappa value for the two modalities was 0.642 (P < 0.05).

CONCLUSION: NBI-ME can improve the diagnosis of early gastric cancer. When early gastric cancer is diagnosed by NBI-ME, further intervention treatment is required.

• Early gastric cancer
• Narrow-band imaging
• Magnifying endoscopy
• Pathology
• Diagnosis

Gastric adenocarcinoma generally culminates via the inflammation-metaplasia-dysplasia-carcinoma sequence progression. The prevalence of gastric adenomas shows marked geographic variation. Recently, the rate of diagnosis of low-grade dysplasia (LGD) has increased due to increased use of upper endoscopy. Many investigators have reported that gastric high-grade dysplasia has high potential for malignancy and should be removed; however, the treatment for gastric LGD remains controversial. Although the risk of LGD progression to invasive carcinoma has been reported to be inconsistent, progression has been observed during follow-up. Additionally, the rate of upgraded diagnosis in biopsy-proven LGD is high. Therefore, endoscopic resection (ER) may be useful in the treatment and diagnosis of LGD, especially if lesions are found to have risk factors for upgraded histology after ER, such as large size, surface erythema or depressed morphology. Fatal complications in endoscopic submucosal dissection (ESD) are extremely low and its therapeutic and diagnostic outcomes are excellent. Therefore, ESD should be applied preferentially instead of endoscopic mucosal resection.

• Intraepithelial neoplasia
• Low-grade dysplasia
• Adenoma
• Endoscopic resection
• Endoscopic submucosal dissection

Gastric carcinoma is one of the most common malignant tumors in the world, and the accurate diagnosis of precancerous lesions plays an important role in gastric cancer prevention. Intraepithelial neoplasia is a form of precancerous lesion of gastric cancer, and many efforts have been done to explore the relationship between gastric cancer and dysplasia. Recently, there has been much progress in the research of intraepithelial neoplasia, including genetic changes at the molecular level, the eradication of Helicobacter pylori (H. pylori), regular follow-up and endoscopic therapy. All of these will play an important role in clinical management of this condition. However, the etiological mechanism, influencing factors and malignant transformation of GIN are still unclear. Hence, further multi-center and long-term prospective studies are needed to solve these problems.

• Intraepithelial neoplasia
• Molecular genetics
• Follow-up
• Treatment

Background. Conventional white-light endoscopy and forceps biopsy are insufficient for definitive diagnosis of gastric adenoma. Immunohistochemical studies have reported an obvious phenotypic difference between adenomas and carcinomas. We investigated the utility of narrow-band imaging with magnifying endoscopy (NBI-ME) for mucin phenotypic assessment to differentiate carcinomas from adenomas. Methods. NBI-ME findings were classified into A, B, and AB types, which revealed papillary, tubular pits and groove microstructures, respectively. To investigate A-B classifications retrospectively, 137 patients (155 lesions) that were diagnosed pretherapeutically with adenoma or borderline lesions by biopsy were enrolled. The mucin phenotype was analyzed immunohistochemically in the first 60 lesions. Results. After endoscopic submucosal dissection, A type and AB type lesions were determined histologically as carcinoma (81/82, 99%). B type lesions were adenoma (29/73, 40%) and carcinoma (44/73, 60%). A or AB type correlated to histological carcinomas (sensitivity 65%, specificity 97%, and accuracy 71%). Mucin phenotypes were gastric or gastrointestinal in A type and AB type carcinomas (31/37, 84%) and intestinal in B type adenomas and carcinomas (21/23, 91%). Conclusions. NBI-ME has the advantage of the assessment of mucin phenotypes in gastric carcinomas and adenomas. The proposed A-B classification is useful, especially for differentiation of gastric or gastrointestinal carcinomas from adenomas.