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Updated: Apr 30, 2026
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Evaluation of the Effectiveness of Longitudinal Incision for Endoscopic Submucosal Excavation of Gastric Subepithelial Lesions
Published on: April 28, 2026
Influence of endoscopic submucosal dissection on additional gastric resections
Noboru Kawata1, Naomi Kakushima, Masanori Tokunaga
1Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Suntougun, Shizuoka, 4118777, Japan.
Summary
Endoscopic submucosal dissection (ESD) for early gastric cancer rarely alters subsequent gastrectomy. Most patients receive scheduled surgery, with minimal changes due to ESD scars impacting gastric resection decisions.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endoscopic Procedures
Background:
- Endoscopic submucosal dissection (ESD) is widely used for early gastric cancer (EGC).
- Noncurative resections occur, necessitating further surgical intervention.
- The impact of prior ESD on subsequent gastric surgery requires thorough evaluation.
Purpose of the Study:
- To assess the influence of preceding endoscopic submucosal dissection (ESD) on the type of additional gastric resection performed.
- To determine the frequency of altered surgical plans due to ESD-related changes.
Main Methods:
- Retrospective review of 255 patients undergoing additional gastrectomy post-noncurative ESD.
- Comparison of pre-ESD estimated gastric resection with post-ESD actual resection.
- Analysis of records from a single cancer center (September 2002 - December 2010).
Main Results:
- Only 4 (1.6%) patients required altered gastric resection due to ESD.
- ESD scar contraction near cardia or pylorus necessitated changes in 3 cases.
- 33 patients underwent standard gastrectomy due to deep invasion or positive margins; 10 had pT2 or deeper pathology.
Conclusions:
- Preceding ESD minimally impacts the extent of additional gastric resection in most cases (98.4%).
- ESD scar contraction, though rare, can necessitate surgical area modification for specific lesion locations.
- The study confirms the general safety and predictability of planned gastrectomy following noncurative ESD.
