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How to manage pyloric tumours that are difficult to resect completely with endoscopic resection: comparison of the retroflexion vs. forward view technique.

 Jun Chul Park  ;  Jie-Hyun Kim  ;  Young Hoon Youn  ;  Kyungseok Cheoi  ;  Hyunsoo Chung  ;  Hyunki Kim  ;  Hyuk Lee  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Hoguen Kim  ;  Hyojin Park  ;  Sang In Lee  ;  Yong Chan Lee 
 DIGESTIVE AND LIVER DISEASE, Vol.43(12) : 958-964, 2011 
Journal Title
Issue Date
Adenocarcinoma/pathology ; Adenocarcinoma/surgery* ; Adult ; Aged ; Aged, 80 and over ; Dissection ; Female ; Gastric Mucosa/pathology ; Gastric Mucosa/surgery* ; Gastroscopy/methods* ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology* ; Pylorus/pathology ; Pylorus/surgery* ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery* ; Treatment Outcome
Endoscopic submucosal dissection ; Prepyloric tumour ; Retroflexion
BACKGROUND: It is difficult to perform complete resection of prepyloric tumours, especially those involving pyloric channel due to incomplete visualisation and insufficient resection margin with forward view.

AIM: To investigate outcomes of endoscopic submucosal dissection for pyloric tumours, we assess effectiveness of retroflexion view technique in comparison with forward view technique.

METHODS: We investigated 47 prepyloric tumours treated by endoscopic submucosal dissection and compared results of forward view technique with those of retroflexion view technique.

RESULTS: Of the 47 prepyloric tumours, 23 lesions had pyloric channel involvement (group 1) and 24 lesions did not (group 2). The en bloc resection, curative resection and complete resection rates for all endoscopic submucosal dissection cases were 80.9, 85.1 and 70.2%, respectively. The en bloc resection, curative resection and complete resection rates were significantly lower in group 1 than group 2. Of the tumours involving pyloric channel except 3 cases which were extended to duodenum, 12 lesions were resected with retroflexion and 8 lesions with forward. Curative resection rate was higher in retroflexion group than forward group (91.7% vs. 37.5%; p=0.018). None of the patients experienced perforation or pyloric stenosis.

CONCLUSIONS: Endoscopic submucosal dissection using retroflexion manoeuvre is a more effective method for the curative resection of gastric tumours involving pyloric channel.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Kim, Hyunki(김현기) ORCID logo https://orcid.org/0000-0003-2292-5584
Kim, Hogeun(김호근)
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Sang In(이상인)
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Lee, Hyuk(이혁)
Cheoi, Kyung Seok(최경석)
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