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Updated: Jul 16, 2026
Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
Published on: April 28, 2026
Endoscopic submucosal dissection of stomach neoplasms after unsuccessful endoscopic resection
M Fujishiro1, O Goto, N Kakushima
1Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Tokyo, Japan. mtfujish-kkr@umin.ac.jp
Background:
Endoscopic submucosal dissection is a novel endoluminal endoscopic surgery that enables resection of pre-malignant and early-stage malignant gastrointestinal neoplasms in an en bloc fashion.
Aim:
To assess the feasibility of endoscopic submucosal dissection of stomach neoplasms with submucosal fibrosis caused by unsuccessful endoscopic resection.
Patients And Methods:
Stomach endoscopic submucosal dissection was performed in ten consecutive patients who had unsuccessful endoscopic tumour resection at another hospital between 2003 and 2006. Seven patients had recurrent tumours after complete endoscopic resection, and three patients had incomplete resections due to complications or technical difficulties. Technical feasibility and follow-up data were collected from the patients' reports.
Results:
All tumours were resected by endoscopic submucosal dissection in one piece without complications. R0 resection (en bloc resection with tumour-free margins) was achieved in nine patients (90%). One patient received additional surgery (gastrectomy) because of submucosal deep invasion with vascular infiltration of the cancer. All patients, including the patient with gastrectomy, have survived without recurrence during a mean follow-up period of 21.4 months (range 3-36 months).
Conclusions:
Endoscopic submucosal dissection is an effective and safe method for resection of stomach neoplasms after unsuccessful endoscopic resection.
Insights
Endoscopic submucosal dissection effectively resects stomach neoplasms with prior failed endoscopic removal. This safe procedure achieved high success rates in patients with recurrent or incomplete resections.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Oncology
Background:
- Endoscopic submucosal dissection (ESD) is an advanced endoscopic surgery for removing gastrointestinal neoplasms.
- ESD allows for en bloc resection of pre-malignant and early-stage malignant tumors.
Purpose of the Study:
- To evaluate the feasibility of ESD for stomach neoplasms.
- To assess ESD's efficacy in cases with submucosal fibrosis from prior unsuccessful endoscopic resections.
Main Methods:
- ESD was performed on ten patients with stomach neoplasms previously treated unsuccessfully.
- Data on technical feasibility and patient follow-up were collected.
Main Results:
- All tumors were successfully resected in one piece via ESD without immediate complications.
- R0 resection was achieved in 90% of patients; one required gastrectomy due to deep invasion.
- All patients survived without recurrence during a mean follow-up of 21.4 months.
Conclusions:
- Endoscopic submucosal dissection is a safe and effective treatment for stomach neoplasms.
- ESD is a viable option for managing residual or recurrent tumors after prior endoscopic resection failures.