Safety and efficacy of endoscopic submucosal dissection for early gastric remnant cancers post-proximal gastrectomy with jejunal interposition

Introduction: Endoscopic submucosal dissection has been widely accepted as a standard treatment for early gastric cancers. However, endoscopic submucosal dissection for an early gastric remnant cancer post-proximal gastrectomy with jejunal interposition is not yet widespread. Case Series: A large, flat, elevated lesion was detected in an 83-year-old male (Case 1), whereas two separate flat, elevated lesions were detected in a 75-year-old male (Case 2). Successful curative en bloc resection of these lesions by endoscopic submucosal dissection using the insulation-tipped diathermic knife-2 revealed well-differentiated adenocarcinoma confined to the mucosa. No postoperative bleeding nor perforation was observed in the present cases. Conclusion: These cases underscore the importance of periodic upper gastrointestinal endoscopy follow-up and the value of endoscopic submucosal dissection using the insulationtipped diathermic knife-2 for treating early gastric remnant cancers post-proximal gastrectomy in the presence of interposed jejunum, even when extensive removal is necessary. Kaoru Omori1, Kanako Yoshida1, Toshiaki Kamei2, Masahiro Kan1 Affiliations: 1MD, PhD, Department of Gastroenterology and Hepatology, Sato Daiichi Hospital, 77-1 Hokyoji, Usa City, Oita 879-0454, Japan; 2MD, PhD, Medical Director of Pathology & Cytology Center BML group PCL, 5-20-25 Matsushima, Fukuoka City, Fukuoka 813-0062, Japan. Corresponding Author: Masahiro Kan, MD, PhD, Department of Gastroenterology and Hepatology, Sato Daiichi Hospital, 77-1 Hokyoji, Usa City, Oita 879-0454, Japan; Email: [email protected] Received: 30 May 2016 Accepted: 20 July 2016 Published: 02 August 2016 S RIES PEER REVIEWED | OPEN A CE S