Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Underestimation of endoscopic size in large gastric epithelial neoplasms

  • Jae Sun Song (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Byung Sun Kim (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Min A Yang (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Young Jae Lee (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Gum Mo Jung (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Ji Woong Kim (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center) ;
  • Jin Woong Cho (Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center)
  • Received : 2021.11.03
  • Accepted : 2022.02.09
  • Published : 2022.11.30
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Abstract

Background/Aims: Endoscopic submucosal dissection (ESD) is an effective method for resecting gastric adenomas and adenocarcinomas. A significant discrepancy was observed between endoscopic and pathological sizes in samples obtained from patients undergoing ESD. This study elucidates the factors affecting size discrepancy after formalin fixation. Methods: The records of 64 patients with 69 lesions were analyzed, including 50 adenomas and 19 adenocarcinomas. Data on location, gross shape, histology, and size after fixation in formalin were collected. Results: The mean size of the resected specimen appeared to decrease after formalin fixation (37.5 mm prefixation vs. 35.8 mm postfixation, p<0.05). The mean long axis diameter of the lesions was 20.3±7.9 mm prefixation and 13.4±7.9 mm postfixation. Size differences in lesions smaller than 20 mm were significantly greater than those in lesions larger than 20 mm (7.6±5.6 mm vs. 2.5±5.8 mm, p<0.01). In multivariate analysis, a tumor size of ≥20 mm was found to be an independent factor affecting size postformalin fixation (p<0.05). Conclusions: The endoscopic size of lesions before ESD may be underestimated in tumors larger than 20 mm in size. Therefore, increased attention must be paid during ESD to avoid instances of incomplete resection.

Keywords

Acknowledgement

I would like to express my sincere gratitude to all the doctors and nurses of the Gastrointestinal Endoscopy Center in the Presbyterian Medical Center, Jeonju, Korea.

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