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[Gastric cancer 776. large adenoma of the cardia]

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70 years old lady visited my clinic due to an adenoma of the cardia involving at least 3/4 of the circumference, which was detected during the screening endoscopy. In the local hospital, endoscopic resction was tried but failed. Actually the procedure stopped in the middle of the marking step. Surgical treatment was recommended in that hospital. What's your option for this woman?

I decided to try endoscopic resection again, although the procedure would be very difficult. I gave full information about the advantages and disadvantages of the endoscopic treatment in this challenging situation.

Endoscopic resection (multiple piecemeal) followed by APC ablation was done. The procedure time was 42 minutes. PPI with oral steroid (4 weeks course) was given for the prevention of the stricture.

The final pathology was acceptable.

Tubulovillous adenoma with high grade dysplasia ;
1. Location : cardia
2. Gross type : elevated
3. Size of adenoma : (1) longest diameter, 24 mm (2) vertical diameter, 15 mm
4. Resection margin : involved distal resection margin by adenoma negative other resection margins

Endoscopic resection of the gastric neoplasms is getting more and more difficult for me, because easy cases are treated in the local clinic. Challenging cases are referred so often. It is time to think about early retirement.

© 일원내시경교실 바른내시경연구소 이준행. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng. (2019-8-7)