Aliaga Ramos J, Arantes VN. Impact of gastric neoplasms location on clinical outcome of patients treated by endoscopic submucosal dissection. World J Gastrointest Endosc 2025; 17(7): 107911 [DOI: 10.4253/wjge.v17.i7.107911]
Corresponding Author of This Article
Josué Aliaga Ramos, MD, Department of Gastroenterology, Hospital José Agurto Tello-Chosica, No. 229 Walter Stubbs Street, Lima 15801, Peru. arjosue3000@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2025; 17(7): 107911 Published online Jul 16, 2025. doi: 10.4253/wjge.v17.i7.107911
Impact of gastric neoplasms location on clinical outcome of patients treated by endoscopic submucosal dissection
Josué Aliaga Ramos, Vitor Nunes Arantes
Josué Aliaga Ramos, Department of Gastroenterology, Hospital José Agurto Tello-Chosica, Lima 15801, Peru
Josué Aliaga Ramos, Gastroenterology Service, Clinica Madre Zoraida, Lima 15801, Peru
Josué Aliaga Ramos, Digestive Endoscopy Unit Hospital San Juan de Matucana, Lima 15801, Peru
Vitor Nunes Arantes, Endoscopy Unit, Alfa Institute of Gastroenterology, Belo Horizonte 30130-100, Brazil
Vitor Nunes Arantes, School of Medicine, Federal University of Minas Gerais , Belo Horizonte 30130-100, Brazil
Vitor Nunes Arantes, Hospital Mater Dei Contorno, Belo Horizonte 30130-100, Brazil
Co-first authors: Josué Aliaga Ramos and Vitor Nunes Arantes.
Author contributions: Aliaga Ramos J and Arantes VN designed this study, performed the research and project administration, wrote the original draft and final draft, and made equal contributions to this manuscript as co-first authors; All authors approved the final manuscript.
Institutional review board statement: This study took place in an endoscopic referral center in Brazil approval by the Institutional Review Board, obtained on May 6, 2020.
Informed consent statement: The authors declare that the study consisted of a retrospective assessment of the clinical impact of the location of superficial gastric neoplasms on the performance of gastric endoscopic submucosal dissection and was conducted in accordance to the Declaration of Helsinki.
Conflict-of-interest statement: The authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Josué Aliaga Ramos, MD, Department of Gastroenterology, Hospital José Agurto Tello-Chosica, No. 229 Walter Stubbs Street, Lima 15801, Peru. arjosue3000@gmail.com
Received: April 2, 2025 Revised: April 29, 2025 Accepted: June 16, 2025 Published online: July 16, 2025 Processing time: 100 Days and 7.1 Hours
Abstract
BACKGROUND
The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection (ESD). There are few studies that analyze the influence of tumor location in the stomach on ESD outcomes.
AIM
To compare the clinical efficacy and safety of ESD in the proximal vs distal stomach.
METHODS
A retrospective analysis was conducted on patients admitted in chronological order who received gastric ESD between 2009 and 2024. Patients were stratified into two groups based on tumor location: Group 1 included patients with tumors in the lower third of the stomach, while Group 2 included those with tumors in the middle or upper third. The following parameters were evaluated for each group: procedure duration, curative resection rate, en bloc resection rate, complete resection rate, incidence of complications, and depth of neoplastic invasion.
RESULTS
The mean procedure time was 97.07 minutes for lesions located in the distal stomach and 129.08 minutes for those in the proximal stomach (P = 0.0011). En bloc resection rates for ESD in the distal and proximal stomach were 97.9% and 85.7%, respectively (P = 0.0016), while complete resection rates were 93.9% and 73.4%, respectively (P = 0.0002). Curative resection was achieved in 90.9% of distal lesions compared to 65.3% of proximal lesions (P = 0.0001). Submucosal invasion was identified in 4.0% of distal lesions and 14.2% of proximal lesions (P = 0.013).
CONCLUSION
ESD performed in the proximal stomach requires a longer procedural time compared to ESD in the distal stomach, independent of lesion size and histopathological characteristics. Additionally, proximal gastric ESD is associated with reduced clinical efficacy and increased incidence of submucosal invasion.
Core Tip: The location of gastric neoplasms in endoscopic submucosal dissection (ESD) may affect the level of technical difficulty and the efficacy and safety profile. There is limited scientific evidence assessing the clinical impact of gastric tumor location on ESD outcomes. In tumors in the proximal stomach, it is essential to carefully and individually select those cases that would benefit from gastric ESD eradication.
