Clinical outcomes of extensive endoscopic submucosal dissection involving more than three-fourths of the circumference for gastric epithelial neoplasia.

BACKGROUND

The aim of this study was to evaluate the clinical outcomes of extensive submucosal dissection involving more than three-fourths of the circumference (eESD) for gastric epithelial neoplasia.

METHODS

Consecutive patients treated by eESD for gastric epithelial neoplasia were retrospectively included at 7 medical centers between 2015 and 2025. Short-term outcomes were en bloc resection, R0 resection, curative resection, procedure time, and adverse events, whereas long-term outcomes were local recurrence rate (LRR), simultaneous multiple carcinomas incidence rate (SMCIR), heterochronous multiple carcinomas incidence rate (HMCIR), and cancer metastasis incidence rate (CMIR).

RESULTS

Forty-three patients with 47 lesions (median tumor size: 6.0 cm) were analyzed. The en bloc resection, R0 resection, and curative resection rates were 100, 97.9, and 93.6%, respectively. The median procedure time was 115 min. Two patients had postoperative fever (4.7%) and two patients had delayed bleeding (4.7%). Postoperative abdominal pain occurred in 30 patients (69.8%). No patient occurred intraoperative and delayed perforations. Eight patients experienced post-eESD pyloric stenosis (18.6%). Within a median follow-up of 32.0 months, the LRR, SMCIR, HMCIR, and CMIR were 4.7, 2.3, 0.0, and 2.3%, respectively. Transverse extent of the mucosal defect more than 64 mm was a significant risk factor for post-eESD pyloric stenosis (OR: 15.99, 95% CI: 1.56-163.66, P = 0.017). Tumor depth of invasion (submucosal invasion depth ≥ 500 μm) was a significant risk factor for lymphovascular invasion (OR: 71.13, 95% CI: 3.03-1672.42, P = 0.008).

CONCLUSION

eESD for gastric epithelial neoplasia might be technically feasible and highly curative treatment.