Metachronous early gastric cancer successfully treated twice with endoscopic submucosal dissection: A case report.

RATIONALE: Metachronous early gastric cancer may arise years after curative endoscopic resection of an index lesion. Evidence on the feasibility of a second endoscopic submucosal dissection (ESD) remains limited.

PATIENT CONCERNS: A 45-year-old asymptomatic man underwent routine surveillance 5 years after curative ESD for a well-differentiated intramucosal tubular adenocarcinoma of the mid-gastric body.

DIAGNOSES: Magnifying narrow band imaging revealed a 20-mm flat erythematous lesion on the anterior wall of the gastric angle. Biopsy confirmed well-differentiated tubular adenocarcinoma confined to the mucosa.

INTERVENTIONS: Repeat ESD achieved en-bloc resection with negative horizontal and vertical margins. Histopathology showed intramucosal carcinoma without lymphovascular invasion (eCuraA).

OUTCOMES: The patient recovered uneventfully and remained disease-free at 12-month follow-up.

LESSONS: For patients with metachronous early gastric cancer meeting curative endoscopic resection criteria, a second ESD is technically feasible, oncologically curative, and preferable to surgery, sparing them the significant morbidity of gastrectomy.