[Biopsies after ESD for EGC]

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The role of endoscopy after ESD is to find the recurrence. There are two kinds of recurrence that can be found in the endoscopy: (1) local, (2) metachronous.

In patients with ESD induced ulcer, surveillance biopsy is very important to find early recurrence in ESD site. The overall incidence of metachronous recurrence is 4.7% to 8.2% during 5 years after ESD. Endoscopists have to keep in mind chance of metachronous recurrence during endoscopic surveillance.

Local recurrence

Metachronous recurrence

(1) Within 3 years of ESD: If the local recurrence is not suspected, take 2 biopsies from ESD-induced ulcer. If the local recurrence is suspected (such as nodular change), take 2 or more biopsies from that area. Take pictures immediately after the biopsy to document the exact biopsy site.
(2) After 3 years of ESD: If the local recurrenc is not suspected, you don't need to take biopsy.