Utility of Endoscopic Submucosal Dissection in the Remnant Stomach and Clinical Outcomes for Different Reconstruction Methods

BACKGROUND: The number of patients with remnant gastric tumor during postoperative follow-up is increasing. We evaluated clinical outcomes to determine the feasibility of endoscopic submucosal dissection (ESD) for early gastric neoplasm in the remnant stomach. METHODS: We compared 138 lesions of ESD in the remnant stomach after proximal gastrectomy, distal gastrectomy (DG) or pylorus-preserving DG with 3,237 lesions of ESD in the intact stomach. ESD was performed at our hospital between January 2005 and September 2017. RESULTS: Compared with the intact group, the remnant group had significantly longer mean procedure duration and lower rates of curative resection (all p < 0.01). However, complication rates did not differ significantly between the 2 groups. Among the reconstruction techniques after DG, the rate of lesions at the anastomosis site was significantly higher and the mean procedure duration was significantly longer after Billroth II reconstruction (both p < 0.01). Also, curative resection rate was significantly lower after Billroth II (50.0%) than after Billroth I (p < 0.05). CONCLUSIONS: Although technically demanding, ESD for early gastric tumor in the remnant stomach was a safe and effective therapeutic method. However, because the curative resection rate was lower for the more frequent lesions occurring at the anastomosis site after Billroth II reconstruction, early detection of remnant stomach tumor is desirable after Billroth II reconstruction following DG.