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Safety and efficacy of endoscopic submucosal dissection for early gastric remnant cancers post-proximal gastrectomy with jejunal interposition
Kaoru Omori1, Kanako Yoshida1, Toshiaki Kamei2, Masahiro Kan1
1MD, PhD, Department of Gastroenterology and Hepatology, Sato Daiichi Hospital, 77-1 Hokyoji, Usa City, Oita 879-0454, Japan.
2MD, PhD, Medical Director of Pathology & Cytology Center BML group PCL, 5-20-25 Matsushima, Fukuoka City, Fukuoka 813-0062, Japan.

Article ID: 100021Z10KO2016
doi:10.5348/Z10-2016-21-CS-12

Address correspondence to:
Masahiro Kan
MD, PhD, Department of Gastroenterology and Hepatology
Sato Daiichi Hospital, 77-1 Hokyoji, Usa City
Oita 879-0454
Japan

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How to cite this article:
Omori K, Yoshida K, Kamei T, Kan M. Safety and efficacy of endoscopic submucosal dissection for early gastric remnant cancers post-proximal gastrectomy with jejunal interposition. J Case Rep Images Oncology 2016;2:47–51.


Abstract
Introduction: Endoscopic submucosal dissection has been widely accepted as a standard treatment for early gastric cancers. However, endoscopic submucosal dissection for an early gastric remnant cancer post-proximal gastrectomy with jejunal interposition is not yet widespread.
Case Series: A large, flat, elevated lesion was detected in an 83-year-old male (Case 1), whereas two separate flat, elevated lesions were detected in a 75-year-old male (Case 2). Successful curative en bloc resection of these lesions by endoscopic submucosal dissection using the insulation-tipped diathermic knife-2 revealed well-differentiated adenocarcinoma confined to the mucosa. No postoperative bleeding nor perforation was observed in the present cases.
Conclusion: These cases underscore the importance of periodic upper gastrointestinal endoscopy follow-up and the value of endoscopic submucosal dissection using the insulation-tipped diathermic knife-2 for treating early gastric remnant cancers post-proximal gastrectomy in the presence of interposed jejunum, even when extensive removal is necessary.

Keywords: Early gastric remnant cancer, Endoscopic submucosal dissection, Proximal gastrectomy, Insulation-tipped diathermic knife-2


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Author Contributions:
Kaoru Omori – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kanako Yoshida – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Toshiaki Kamei – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Masahiro Kan – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
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The corresponding author is the guarantor of submission.
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Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Kaoru Omori et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.