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Poster Presentation Abstracts PUG-01 interval from endoscopic examination can increase the likelihood of less invasive endoscopic resection. Endosc End scopi opic Surveillanc llance Can I e Can Incr crease ease the Chanc the Chance Keyw ywor ords: ds: Endoscopy, gastric cancer, surveillance of of R Resectabilit sectability and End and Endosc scop opic T ic Treat eatment in ent in Gas Gastric C Canc ncer Ji Yong Ahn, Hwoon-yong Jung, Ji Young Choi, Jeong Hoon Lee, PUG-02 Kwi-sook Choi, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee and Jin-ho Kim Ser Serum P m Pepsinogen L psinogen Levels and ls and the Statu the Status o of Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea Heli licobact bacter Pylori Pylori Infect ction in ion in Predi edicting the ng the Cell T ll Types pes of of Gas Gastric N Neop oplasm lasm Background Backg ound / / aim aims: : Little is known about the effects of periodic endoscopic screening before detection of pri- Hong Seok Choi, Sun-young Lee, Jeong Hwan Kim, In-kyung Sung, Hyung Seok Park, Chan Sup Shim, Choon Jo Jin and Yong Hwang mary gastric cancer on clinical outcomes in endoscopi- Internal Medicine, Konkuk University School of Medicine, Seoul, Korea cally resected patients. We therefore compared clinical outcomes in patients who did and did not undergo en- Background Backg ound / / aim aims: : A combination of serum PG levels doscopy before diagnosis. and Helicobacter pylori serology are used as a bio- marker strategy for detection of individuals at increased Methods: thods: Between January 2009 and November 2011, risk of gastric neoplasm based on Correa’s hypothesis. 769 patients (507 men, mean age 60.1±11.7 years) were We aimed to uncover whether this combination meth- referred to Asan Medical Center after diagnosis of gas- od could predict the risk and cell type of gastric tric cancer at another hospital. Clinical outcomes were neoplasm. compared in patients who had (n=512) and had not (n=257) undergone endoscopic screening before diag- Me Methods: This study was based on the data of 2428 asymp- nosis of gastric cancer. Factors affecting tumor resect- tomatic Korean adults who underwent serum PG tests, ability and the possibility of endoscopic resection were H. pylori serology, and esophagogastroduodenoscopy analyzed. (EGD) on the same day at our center. Subjects who had gastric surgery, with extragastric malignancy were ex- Results: In the non-examined group, 225 patients Re cluded from the analysis (n=337). Definite diagnosis (87.5%) had resectable gastric cancers and were treated for gastric corpus atrophy was given when PG I/II ratio surgically (n=151, 67.1%) or by endoscopic resection was less than 3, PG I level was less than 70 ng/ml, and (n=74, 32.9%). In the examined group, 493 patients the EGD finding showed chronic atrophic gastritis. (96.3%) had resectable tumors and were resected surgi- cally (n=243, 49.3%) or endoscopically (n=250, 50.7%). Results: Of 2031 subjects, 11 subjects were diagnosed as Re Multivariate analysis showed that initial symptoms, gastric neoplasm incidentally (Table 1). Of 792 atro- lack of endoscopic screening, and lower serum albumin phy(-)/ H. pylori (-) subjects, 1 poorly cohesive carcino- concentration were independently associated with tu- ma and 2 adenomas with high-grade dysplasia were mor unresectability. Of the 718 patients with resectable found (0.379%). Of 1016 atrophy(-)/ H. pylori (+) sub- tumors, 394 underwent surgery and 324 underwent en- jects, 2 adenocarcinoma and 2 adenomas with doscopic resection. Multivariate analysis showed that low-grade dysplasia were found (0.393%). Of 210 atro- older age, lack of initial symptoms, ≤ 1 year interval be- phy(+)/ H. pylori (+) subjects, 1 adenocarcinoma and 2 tween endoscopy and tumor detection, and higher se- adenomas with low-grade dysplasia were found rum albumin were independently associated with en- (1.429%). Of 13 atrophy(+)/ H. pylori (-) subjects, 1 ad- doscopic resection. enoma with low-grade dysplasia was found (7.692%). Conc nclusi sions: ons: Previous endoscopy, especially in asymp- Conc nclusi sions: ons: Incidental gastric neoplasm is most com- tomatic patients with proper nutritional status, can in- mon in atrophy(+)/ H. pylori (-) group followed by atro- crease gastric cancer resectability. Moreover, a ≤ 1 year phy(+)/ H. pylori (+), atrophy(-)/ H. pylori (+), and atro IDEN 2013 / 12 th KJSGE 391
IDEN 2013 / 12 th KJSGE Table 1. Incidentally found gastric neoplasms according to Re Results: After endoscopic resection, 434 lesions were di- the status of H. pylori infection and atrophic gastritis agnosed as adenomas, and 60 lesions were diagnosed as adenocarcinoma. The diameter of the lesions was 21.29±8.7mm in the adenoma group and 23.53±10.1mm in the adenocarcinoma group. On post-resection tissue biopsies, adenocarcinomas were diagnosed more fre- quently among depressed adenomas(20.9%) than non- depressed adenomas.(9.0%) ( p <0.001, OR=2.663) Similarly, adenocarcinoma were diagnosed more frequently among adenomas with ulceration(31.2%) than without ulcer- ation (10.8%) ( p =0.002, OR=3.745). In the multivariate phy(-)/ H. pylori (-) groups. Although atrophy(-)/ H. py- analysis, combined high-grade dysplasia, red discoloration lori (-) group shows the lowest incidence, it shows most were significant variables associated with carcinomas. advanced histology such as poorly cohesive carcinoma Conc nclusi sions: ons: Gastric adenomatous lesions with endo- and adenoma with high-grade dysplasia suggesting a scopic findings such as a depressed type, red discoloration, rapid progression of gastric neoplasm. mucosal ulceration, and high-grade dysplasia should be Keyw ywor ords: ds: Serum pepsinogen, helicobacter pylori, gas- considered for endoscopic resection. tric cancer Keyw ywor ords: ds: Gastric adenoma; Gastric adenocarcinoma; Endoscopic submucosal dissection; Endoscopic findings PUG-03 Endosc Endoscopi opic Finding Findings S Suggest ggesting ng Adenocar enocarcino cinoma ma PUG-04 of of Gas Gastric Lesions I Lesions Init itial ially Diag Diagno nosed A sed As Endosc End scopi opic Charact aracteristic ics A s Assoc ssociat ated w ed with t the e Ad Adenomas by Fo Forc rceps B Biopsy Occu Oc currenc ence o of Miss ssed S ed Sync nchr hronou ous G s Gast stric c Jae Un Lee, Jin Woong Cho, Wang Guk Oh, So Hee Yun, Moon Sik Park, Neopl oplasms sms Shang Hoon Han, Young Jae Lee, Gum Mo Jung, Yong Keun Cho and Ji Woong Kim Moon Sik Park, Jin Woong Cho, Wang Guk Oh, Jae Un Lee, So Hee Yun, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea Shang Hoon Han, Young Jae Lee, Gum Mo Jung, Ji Woong Kim and Yong Keun Cho Backg Background ound / / aims: aims: Endoscopic resections are widely Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea implemented for the management of gastric neoplasia. Backg Background ound / aim / aims: : A few studies have been published But, histologic results between the forcep biopsy sam- on missed synchronous lesions (MSLs) after endo- ples and post-endoscopic resection specimens may be scopic submucosal dissection (ESD), but the data of en- different. The aim of this study was to evaluate endo- doscopic characteristics of MSLs are lacking. The aims scopic findings of gastric adenocarcinoma that are ini- of our study were to define differences between missed tially diagnosed as adenomas by forceps biopsy. synchronous gastric neoplasms and unmissed gastric Methods: thods: We retrospectively reviewed 494 lesions diag- neoplasms, and to determine the endoscopic character- nosed as gastric adenomas by forceps biopsy from istics of MSLs after ESD. January 2008 to June 2012. The endoscopic findings Methods: thods: From January 2008 to June 2012, 586 patients were reviewed for location, size, gross appearance, ul- with early gastric cancers (EGCs) or gastric adenomas ceration and surface color. All patients underwent en- who had undergone ESD were included. We compared doscopic resection and we compared the difference be- clinicopathologic factors and endoscopic character- tween the biopsy results before and after endoscopic istics between patients with MSLs group and patients submucosal dissection(ESD). 392 IDEN 2013 / 12 th KJSGE
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