Recurrence and Long-Term Outcomes After Curative ESD for Multiple Early Gastric Neoplasms

Overview

This single-center study evaluated 810 patients undergoing curative endoscopic submucosal dissection (ESD) for early gastric neoplasms, comparing outcomes between solitary lesions and synchronous multiple early gastric neoplasms (SM-EGN). While short-term ESD outcomes were comparable, patients with SM-EGN exhibited a higher long-term risk of metachronous recurrence, highlighting the role of field cancerization.

Background

Early gastric neoplasia (EGN), including low-grade dysplasia and early gastric cancer, is increasingly detected due to advances in endoscopic imaging. Endoscopic submucosal dissection (ESD) is the standard curative treatment for EGN without lymph node metastasis, allowing en bloc resection and gastric preservation. The detection of synchronous multiple primary EGNs (SM-EGN) has risen, representing 5–15% of cases and suggesting a field cancerization effect, where widespread mucosal alterations predispose to new lesions. Prior studies have noted higher metachronous recurrence in SM-EGN but lacked comprehensive analysis of cumulative recurrence and predictors.

Data Highlights

Key Findings

• Among 810 patients, 77 (9.5%) had synchronous multiple early gastric neoplasms (SM-EGN), all resected in a single ESD session.
• Median follow-up was approximately 4 years, with similar overall survival between SM-EGN and solitary lesion groups.
• SM-EGN patients had a significantly higher risk of metachronous gastric neoplasia compared to solitary EGN patients.
• Recurrence analysis included patient- and lesion-level data, with evaluation of second recurrence events, providing a comprehensive risk assessment.
• Independent predictors of recurrence were identified, emphasizing the influence of field cancerization in SM-EGN patients.
• Short-term ESD outcomes such as en bloc and curative resection rates were comparable between groups, supporting the safety and efficacy of simultaneous ESD for SM-EGN.

Clinical Implications

Clinicians should recognize that patients with synchronous multiple early gastric neoplasms have an elevated long-term risk of metachronous recurrence despite successful curative ESD. Rigorous and prolonged endoscopic surveillance is warranted in this population to detect new lesions early. Understanding the role of field cancerization may guide risk stratification and tailored management strategies.

Conclusion

Simultaneous ESD for synchronous multiple early gastric neoplasms is safe and effective with comparable short-term outcomes to solitary lesions; however, these patients require vigilant long-term surveillance due to increased risk of metachronous recurrence linked to field cancerization.

References

1. Peking University Cancer Hospital Study 2012-2024 -- Recurrence Rates and Long-Term Outcomes After Curative ESD for SM-EGN