Endoscopic submucosal dissection of stomach neoplasms after unsuccessful endoscopic resection

Background: Endoscopic submucosal dissection is a novel endoluminal endoscopic surgery that enables resection of pre-malignant and early-stage malignant gastrointestinal neoplasms in an en bloc fashion. Aim: To assess the feasibility of endoscopic submucosal dissection of stomach neoplasms with submucosal fibrosis caused by unsuccessful endoscopic resection. Patients and methods: Stomach endoscopic submucosal dissection was performed in ten consecutive patients who had unsuccessful endoscopic tumour resection at another hospital between 2003 and 2006. Seven patients had recurrent tumours after complete endoscopic resection, and three patients had incomplete resections due to complications or technical difficulties. Technical feasibility and follow-up data were collected from the patients' reports. Results: All tumours were resected by endoscopic submucosal dissection in one piece without complications. R0 resection (en bloc resection with tumour-free margins) was achieved in nine patients (90%). One patient received additional surgery (gastrectomy) because of submucosal deep invasion with vascular infiltration of the cancer. All patients, including the patient with gastrectomy, have survived without recurrence during a mean follow-up period of 21.4 months (range 3-36 months). Conclusions: Endoscopic submucosal dissection is an effective and safe method for resection of stomach neoplasms after unsuccessful endoscopic resection.