Clinicopathological Study of Minute Gastric Carcinoma in Surgically Resected Multiple Gastric Carcinoma Cases

AIM: Therapeutic endoscopy has been widely adopted, and mostof intramucosal gastric carcinomas are commonly treated by endoscopicsubmucosal dissection (ESD). In order to achieve anappropriate endoscopic treatment, this study is designed to revealmultiple and minute gastric carcinomas, which may be overlookedat preoperative endoscopy.METHODS: We retrospectively examined clinicopathologicalfindings and endoscopic images of 80 carcinoma lesions from 28multiple gastric carcinoma patients. The entire region of resectedstomachs were pathologically examined, after that carcinomas wereevaluated clinicopathological findings, i.e., size, histlogical type,depth of invasion, background mucosa, distribution of the carcinomas,and preoperative diagnosis by endoscopy.Results: The patients with multiple gastric carcinomas were accountedfor 26.9% of all surgically treated cases. There were 17double and 5 triple carcinomas, and 6 quadruple quintuple orsextuple carcinomas. In cases in which the second carcinoma wasdetected, the probability of a third carcinoma was 39.2%. Lesionsafter the third carcinoma were likely to be minute gastric carcinoma(less than 5 mm in size) in which preoperative endoscopic detectionrate was 25%.CONCLUSIONS: During endoscopic treatment for gastric carcinoma,it needs to pay attention to the residual multiple or minutegastric carcinoma in the stomach, which may lead to a predispositionfor metachronous multiple gastric carcinoma. Careful pretherapeuticexamination and follow-up by endoscopy should beperformed to achieve an appropreate endoscopic treatment in casesof multiple gastric carcinomas.