Endoscopic predictive factors associated with local recurrence after gastric endoscopic submucosal dissection

Objective: Endoscopic submucosal dissection (ESD) has been accepted as the treatment of choice for gastric epithelial neoplasia. Endoscopic characteristics of the primary lesion and post-ESD scars may be informative to predict the possibility of local recurrence.Methods: Between November 2008 and July 2015, a retrospective study was conducted in a single-tertiary referral hospital. Consecutive patients who underwent ESD for early gastric cancer (EGC) or high-grade dysplasia were analyzed to evaluate the incidence of local recurrence and associated endoscopic characteristics.Results: A total of 639 lesions were analyzed. The rates of en-bloc and complete resection were 98.1% and 95.5%, respectively. A total of 15 local recurrent lesions were found (2.3%). The endoscopic findings of primary lesions associated with local recurrence were a lesion size 20mm (odds ratio, OR, 4.408; 95% confidence interval, CI, 1.369-14.186, p=.013) and incomplete endoscopic resection (OR 17.059, 95% CI 4.887-59.551, p<.001). During follow-up endoscopic examinations, atypical scar findings (non-flat morphology, erythematous color change and uneven surface pattern) were significant endoscopic findings to predict local recurrence. Local recurrence was absent for ESD scars with even-flat morphology without erythema.Conclusion: Lesions with larger size ( 20mm) and incompletely resected lesions had higher risk of local recurrence. Endoscopic forceps biopsy is unnecessary for even-flat ESD scar without erythematous changes.