Post written by Kyu Yeon Hahn and Jun Chul Park from the Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
The focus of our study was to identify the incidence of recurrent lesions after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) and to determine whether scheduled endoscopic surveillance might improve the detection rate of treatable early-stage recurrent lesions.
Surveillance examination after ESD is important to detect local recurrence or metachronous cancer in early treatable stages. As the number of patients with EGC undergoing ESD increases, consistent guidelines about lifetime surveillance after curative ESD are needed.
First, strict follow-up endoscopy should be done within a year after curative ESD. In our study, 71 patients (5.27%) were diagnosed with recurrence within a year despite undergoing curative ESD. It is important that careful endoscopic examination and adequate biopsy at ESD scar is completed within a year after ESD, especially in cases with a relatively short safety margin and cancers arising from adenomas.
Second, annual surveillance endoscopy should be done for patients after more than a year following curative ESD. We analyzed recurrence patterns and modality of additional treatment according to the last surveillance interval of recurrence cases, calculated from the period of the penultimate endoscopy to the endoscopy which detected the recurrence. There was a significant difference between the short and long surveillance interval group(≤ 12 months vs. > 12 months) in the proportions of recurrent adenocarcinoma (31.9% vs. 60.9%, P = 0.021), additional gastrectomy (7.1% vs. 46.2%, P = 0.033), and size (8.92 ± 4.17 mm vs. 18.08 ± 10.47 mm, P=0.010). At least once a year surveillance endoscopy after more than a year following curative ESD can detect recurrent lesions at a stage early enough for curative endoscopic treatment.
If 10-year or 20-year long-term follow-up data become available, further studies are necessary about when we can start surveillance endoscopy biannually in Korea, such as screening endoscopy in healthy individuals older than 40 years.
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