[Ablation treatment for lateral margin positive cases]

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In cases with lateral margin involvement after ESD, early additional ablation treatment is another important treatment option. In this case, posterior resection margin was positive of malignancy.

Although no residual tumor was suspected in the repeat endoscopy, ablation treatment using argon plasma coagulation (APC) was done. There was no recurrence in the follow-up endoscopies for more than 4 years.

A few weeks ago (in SIDDS 2012), I received a question about the safety of ablation treatment of positive resection margin. The point was that we doní»t know the depth of invasion of the possible residual tumor near the positive resection margin. Letí»s suppose this is the tumor.

Endoscopic resection will be done like this, and one resection margin was positive. Yes, I agree. We doní»t have the information about the depth of invasion of the possible residual tumor. However, we already have information of depth of invasion from most of the tumor. Usually the invasion is deepest in the middle of the tumor.

In this regard, ablation treatment (green area in the picture below) can be done quite safely.