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Feasibility of underwater endoscopic mucosal resection for endoscopic management of gastric neoplasms in patients with familial adenomatous polyposis

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Abstract

Background

Underwater endoscopic mucosal resection (UEMR) has been developed as an effective endoscopic intervention for colon, rectum, and duodenum neoplasms. However, there are no comprehensive reports regarding the stomach, and its safety and efficacy are unknown. We aimed to examine the feasibility of UEMR for gastric neoplasms in patients with familial adenomatous polyposis (FAP).

Methods

We retrospectively extracted data of patients with FAP who underwent endoscopic resection (ER) for gastric neoplasms at Osaka International Cancer Institute from February 2009 to December 2018. Elevated gastric neoplasms of ≤ 20 mm in diameter were extracted, and conventional endoscopic mucosal resection (CEMR) and UEMR were compared. Furthermore, outcomes after ER until March 2020 were examined.

Results

91 endoscopically resected gastric neoplasms were extracted from 31 patients with 26 pedigrees, and 12 neoplasms underwent CEMR and 25 neoplasms underwent UEMR was compared. The procedure time was shorter for UEMR than for CEMR. There was no significant difference between en bloc resection and R0 resection rates by EMR methods. CEMR and UEMR showed postoperative hemorrhage rates of 8% and 0%, respectively. Residual/local recurrent neoplasms were identified in four lesions (4%), but additional endoscopic intervention (three UEMR and one cauterization) resulted in a local cure.

Conclusion

UEMR was feasible in gastric neoplasms of FAP patients, especially in elevated lesions and those of ≤ 20 mm in diameter.

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Acknowledgements

We thank Eri Okuda (Data Manager at the Medical Research Support Co., Ltd.) for acquisition of the data. This study was supported by the Japan Agency for Medical Research and Development (AMED: 19ck0106271h0003). We also thank H. Nikki March, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

This study was funded by the Japan Agency for Medical Research and Development (AMED: 21ck0106271h0002).

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Authors and Affiliations

  1. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan

    Yusaku Shimamoto, Yoji Takeuchi, Kenshi Matsuno, Hiroko Nakahira, Satoki Shichijo, Akira Maekawa, Takashi Kanesaka, Sachiko Yamamoto, Koji Higashino, Noriya Uedo & Ryu Ishihara

  2. PCL Osaka Pathology and Cytology Center, Osaka, Japan

    Shingo Ishiguro

  3. Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan

    Shin-ichi Nakatsuka

  4. Ishikawa Gastroenterology Clinic, Osaka, Japan

    Hiroshi Yunokizaki, Yasumasa Ezoe & Hideki Ishikawa

  5. Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan

    Kenshi Matsuno

  6. Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Hideki Ishikawa

  7. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan

    Yoji Takeuchi

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  1. Yusaku Shimamoto
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Contributions

YS, YT, SI, and HI designed the study. SN, HY, YE, KM, HN, SS, AM, TK, SY, KH, NU, and RI recruited subjects and acquired data. YS and YT analyzed data and wrote the manuscript. All authors have approved the final submitted draft.

Corresponding author

Correspondence to Yoji Takeuchi.

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Disclosures

Yoji Takeuchi has received honoraria from Olympus. Also, Takashi Kanesaka has received honoraria from Olympus. This organization had no role in the design, practice, or analysis of the study reported in this manuscript. Drs. Yusaku Shimamoto, Shingo Ishiguro, Shin-ichi Nakatsuka, Hiroshi Yunokizaki, Yasumasa Ezoe, Kenshi Matsuno, Hiroko Nakahira, Satoki Shichijo, Akira Maekawa, Sachiko Yamamoto, Koji Higashino, Noriya Uedo, Ryu Ishihara, and Hideki Ishikawa have no conflicts of interest or financial ties to disclose.

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Shimamoto, Y., Takeuchi, Y., Ishiguro, S. et al. Feasibility of underwater endoscopic mucosal resection for endoscopic management of gastric neoplasms in patients with familial adenomatous polyposis. Surg Endosc 37, 6877–6884 (2023). https://doi.org/10.1007/s00464-023-10175-x

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