Endoscopic submucosal dissection as a treatment for gastric adenomatous polyps: predictive factors for early gastric cancer.

OBJECTIVE: Endoscopic forceps biopsy (EFB) sampling of gastric adenoma may provide inadequate specimens for a correct diagnosis and lead to inappropriate follow-up strategies for adenomas or missed carcinoma foci. The aim of this study was to determine the diagnostic concordance between an EFB and resected gastric adenomatous polyps by endoscopic submucosal dissection (ESD) and to know the efficacy of ESD for the treatment of gastric adenomatous polyps.

MATERIAL AND METHODS: Between November 2008 and May 2011, 413 ESDs were carried out at Pusan National University Yangsan Hospital. After exclusion, 282 cases were enrolled. The clinicopathological features, complete resection rate, procedure time, complication rate and associated factors for early gastric cancer (EGC) prediction were analyzed.

RESULTS: The mean age was 62.13 ± 8.91 years. Submucosal dissection results showed that the discrepancy rate between endoscopic biopsy and pathology of resected specimens was 32.9% (93/282). Additionally, 71 cases (25.2%) were adenocarcinomas. Among low-grade dysplasia (LGD) from EFB, 23 cases (11.8%) were adenocarcinomas after ESD. Among high-grade dysplasia (HGD) from EFB, 48 cases (55.2%) were adenocarcinomas after ESD. EFB procedure times were longer in the HGD group than in the LGD group (24.90 vs. 29.88 min, p = 0.017). In multivariate analysis, HGD from EFB, surface redness and lesion diameter were the significant predictive factors for EGC.

CONCLUSIONS: Gastric adenomatous polyps should be removed by endoscopic resection regardless of histopathological type. ESD is a useful method for complete resection of gastric adenomas, regardless of size and location.