Gastric cancer. EndoTODAY

[Gastric cancer 816. ESD for EGC after Whipple's operation for pancreas cancer]

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A 70 years old woman was referred due to a gastric cancer detected in the screening endoscopy after Whipple's operation for pancreatic cancer. The border of the lesion was quite unclear.

Indigocarmine was very useful before the marking. ESD was done with Dual knife (for marking and partial circumferential marking) and IT-2 knife (submucosal dissection).

ESD: Early gastric carcinoma
1. Location : high body, lesser curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, well differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 18 mm (2) vertical diameter, 14 mm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin : free from carcinoma(N), safety margin : distal 7 mm, proximal 6 mm, anterior 12 mm, posterior 10 mm, deep 200 ㎛
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent