The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 255
Poster Session
PS 1058 Gastroenterology (Gastrointestinal Tract) Risk Factors of Additional Gastrectomy after Endo- scopic Submucosal Dissection in Patients with EGC
In Ji Song1, Jun Chul Park1
Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Korea1
Background: Endoscopic submucosal dissection (ESD) is an useful method for com- plete resection of early gastric cancer (EGC). There are some cases that underwent ad- ditional gastrectomy after ESD because of non-curative resection or technical failure such as perforation or bleeding. The purpose of this retrospective study was to analyze risk factors of additional gastrectomy after ESD in patients with EGC.
Methods: From January 2007 to December 2013, we performed ESD for 1,690 lesions in 1,527 EGC patients at severance hospital. To identify risk factors associated to ad- ditional gastrectomy after ESD in patients with EGC, clinicopathologic characteristics (age, sex, underlying disease, Tumor size, location, pathological type, lesion shape such as exudate, ulceration, atrophic change, nodularity, and margin shape) were compared between the patients with and without additional gastrectomy.
Results: Among 1527 patients, 168 (0.1%) patients underwent gastrectomy after ESD because of non-curative resection (n=165) and complications (2 perforations and 1 bleeding). In univariate analysis, history of taking aspirin (P=0.027), large tumor size over 20 mm (<0.001), undifferentiated histology (P<0.001), or presence of exudates (P=0.026), atrophic change (P=0.038), abnormal fold shape (fusion or disruption or smooth tapering) (P=0.019) were signifi cantly related to additional gastrectomy after ESD. In multivariate anaylsis, large tumor size over 20mm (P<0.001), undifferentiated histology (P<0.001), atrophic change (P=0.008), abnormal fold shape (fusion or dis- ruption or smooth tapering) (P=0.044), exudates (P=0.038), elevated margin (P=0.032) were associated with increased risk of additional gastrectomy after ESD.
Conclusions: EGC lesions with large size, undifferentiated histology, atrophic change, abnormal fold shape, exudates and elevated margin were independent risk factors for additional gastrectomy after ESD. Patients should be made aware of these risk factors before undergoing ESD. And when these risk factors are combined, ESD should be per- formed more carefully.
PS 1060 Gastroenterology (Gastrointestinal Tract) Gastric Hepatoid Adenocarcinoma with Increased Serum Levels of Alpha-Fetoprotein and Prothrombin Induced by Vitamin K Absence Ii in Patient with Chron- ic Liver Disease
Do Chang Moon1, Young Ju Kim1, Tae Seop Lim1, Jin Dong Kim2, Won Joong Jeon2, Hyun Kim3, Hyo Won Park4, Chang Won Ha5
Department of Internal Medicine, Severance Hospital, Yonsei University, Korea1, Department of Internal Medicine, Cheju Halla General Hospital, Korea2, Department of Radiology, Cheju Halla General Hospital Korea3, Department of Surgery, Cheju Halla General Hospital, Korea4, Department of Pathology, Cheju Halla General Hospital, Korea5
Hepatoid adenocarcinoma (HAC) of stomach is a rare type of gastric cancer that pathologically mimics hepatocellular carcinoma. We reported a fi rst case of gastric HAC with high serum levels of alpha-fetoprotein (AFP) and prothrombin induced by vitamin K absence II (PIVKA-II). A 75-year-old man was hospitalized with complaint of weight loss and elevation of AFP (299.14 ng/mL) and PIVKA-II (4124 mAU/mL). Viro- logic markers suggested the patient was inactive hepatitis B virus (HBV) carrier. There was a large ulcerating mass involving gastric body on dynamic computed tomography scan and gadoxetic acid-enhanced magnetic resonance imaging, but no intrahepatic lesion was noted. Upper endoscopy revealed an ulcerofungating gastric mass. Total gastrectomy was performed and the tumor showed histological features of typical HAC and diffuse immunohistochemical positivity for AFP. Serum levels of AFP and PIVKA-II decreased to normal range after surgery.
