Two cases of an early gastric cancer with over 40-mm in size resected by a single piece using submucosal dissection EMR

Abstract

We experienced two early gastric cancers, with over 40 mm in size, resected by a single piece using submucosal dissection EMR.
The first patient was a 61-year-old man with an early gastric cancer (type 0-I) at the greater curvature of the lower body measuring 4 cm in diameter. Biopsy taken from the tumor revealed a papillary adenocarcinoma and endoscopic ultrasonograhy (EUS) demonstrated that the tumor did not invade the submucosa. Submucosal dissection EMR using an electro-surgical snare and a flex knife was performed. The lesion was completely resected with one piece. The size of the resected specimen was 46×45mm. Histological examination showed an early gastric cancer type 0-I (sm², pap, INFβ, ly1, v0) . Additional surgical resection was carried out, but no metastatic lesion was detected in the regional lymph nodes.
The second patient was an 88-year-old woman with an early gastric cancer (type 0-IIa) at the lesser curvature of the lower body, EUS demonstrated that the tumor did not invade the submucosa. Submucosal dissection EMR was performed in the same way as the first case. The resected specimen was 40×35mm and histological findings showed an early gastric cancer type 0-IIa (sm1, tub1＞tub2, INFβ, ly0,v0) . The tumor minimally invaded the submucosa (sm1) with tumor free margins of the resected specimen. Additional surgery was not performed considering her age.
Submucosal dissection EMR makes it possible to remove tumors with one piece regardless of size, which gave us very important pathological findings to determine a complete resection or not.