Negative Histology after Endoscopic Resection: An Endoscopist's Aspect

Shin, Sung Jae; Yang, Min Jae; Noh, Choong Kyun; Lim, Sun Gyo; Lee, Kee Myung; Lee, Kwang Jae

doi:2018.18.1.17

Korean J Helicobacter Up Gastrointest Res > Volume 18(1); 2018 > Article

Review

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2018;18(1):17-20.
DOI: https://doi.org/10.7704/kjhugr.2018.18.1.17 Published online March 10, 2018.

Negative Histology after Endoscopic Resection: An Endoscopist's Aspect

Sung Jae Shin, Min Jae Yang, Choong Kyun Noh, Sun Gyo Lim, Kee Myung Lee, Kwang Jae Lee

Division of Gastroenterology, Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea. shsj9128@ajou.ac.kr

내시경 절제술 후 조직학적 음성 결과: 내시경의의 관점

신성재, 양민재, 노충균, 임선교, 이기명, 이광재

아주대학교 의과대학 아주대학교병원 소화기내과학교실

Correspondence: Sung Jae Shin, Tel: +82-31-219-5119, Fax: +82-31-219-5999,
Email: shsj9128@ajou.ac.kr

Received: 12 January 2018 • Revised: 12 February 2018 • Accepted: 12 February 2018

Abstract

Endoscopic submucosal dissection (ESD) is accepted as the standard treatment for gastric epithelial dysplasia or early gastric cancer because it enables curative en bloc resection and complete histopathological assessment of the specimen. However, occasionally, a tumorous lesion may not be detected, and histopathological discrepancies can occur after ESD. Reportedly, the prevalence of negative histopathological results after endoscopic resection is 2.0~4.4%. Negative histopathological results after endoscopic resection are commonly attributable to complete removal of the lesion via an endoscopic forceps biopsy (EFB) at the time of the initial diagnostic endoscopic examination, an initial histopathological overestimation of the EFB specimen, and incorrect localization of the original tumor with subsequent ESD performed at a wrong site. A small tumor size and surface area are known to be significant endoscopic predictors of negative histopathological results after ESD. Therefore, clinicians should be mindful of the fact that negative histopathological findings observed after endoscopic resection warrant a comprehensive review of all pre-ESD data and an adequate follow-up to determine the cause of these findings and to detect any possibility of local recurrence.

Key Words: Endoscopic resection; Histology; Stomach neoplasms