Gut and Liver 2008; 2(3): 199-204 https://doi.org/10.5009/gnl.2008.2.3.199 Stretching Causes Extensive Changes of Gastric Submucosa: Is It Acceptable to Define 500Ռm as the Safe Margin?
Author Information
Sanghoon Park*, Hoon Jai Chun*, Yong Dae Kwon*, Bora Keum*, Yeon Seok Seo*, Yong Sik Kim*, Yoon-Tae Jeen*, Soon Ho Um*, Chang Duck Kim*, Ho Sang Ryu*, Ji Hye Lee, and Yang-seok Chae
*Institute of Digestive Disease and Nutrition, Department of Internal Medicine, and Department of Pathology, Korea University College of Medicine, Seoul, Korea

Hoon Jai Chun
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

Abstract
Background/Aims: Endoscopic mucosal resection can cure early gastric cancer. The risk of lymphatic metastasis is related to the depth of submucosal invasion by the mucosal malignancy, with a resection depth of 500Ռm generally accepted as a safe cut-off. However, excessive thinning induced by stretching of the resected tissue sometimes preventing a precise diagnosis. We studied the effects of stretching on different layers and sites of gastric tissue. Methods: Porcine stomachs were cut into 2.0×2.0 cm pieces, and pieces from body were stretched to 2.5, 3.0, and 3.5 cm. Pieces from the cardia, body, and antrum were also stretched to 3.0 cm. The thickness of each layer was measured and analyzed statistically. Results: Whole gastric wall and submucosal layers showed gradual thinning, with stretching to 3.5 cm tearing the tissues and resulting in imperfect extension. The submucosa was thinner in body tissue than in cardia and antrum tissues. Stretching to 3.0 cm induced a consistent decrease in submucosal thickness (30-70%). The change in thickness varied widely between individual samples. Conclusions: A resection margin of 500Ռm might be insufficient for the complete removal of malignancy. Moreover, the thickness of the submucosal layer differs with the gastric site and between individuals. Future studies are needed to confirm the findings in human tissue. (Gut and Liver 2008;2:199-204)
Keywords: Stomach neoplasms; Gastric mucosa; Gastroscopy; Submucosa; Stretching
Abstract
Background/Aims: Endoscopic mucosal resection can cure early gastric cancer. The risk of lymphatic metastasis is related to the depth of submucosal invasion by the mucosal malignancy, with a resection depth of 500Ռm generally accepted as a safe cut-off. However, excessive thinning induced by stretching of the resected tissue sometimes preventing a precise diagnosis. We studied the effects of stretching on different layers and sites of gastric tissue. Methods: Porcine stomachs were cut into 2.0×2.0 cm pieces, and pieces from body were stretched to 2.5, 3.0, and 3.5 cm. Pieces from the cardia, body, and antrum were also stretched to 3.0 cm. The thickness of each layer was measured and analyzed statistically. Results: Whole gastric wall and submucosal layers showed gradual thinning, with stretching to 3.5 cm tearing the tissues and resulting in imperfect extension. The submucosa was thinner in body tissue than in cardia and antrum tissues. Stretching to 3.0 cm induced a consistent decrease in submucosal thickness (30-70%). The change in thickness varied widely between individual samples. Conclusions: A resection margin of 500Ռm might be insufficient for the complete removal of malignancy. Moreover, the thickness of the submucosal layer differs with the gastric site and between individuals. Future studies are needed to confirm the findings in human tissue. (Gut and Liver 2008;2:199-204)
Keywords: Stomach neoplasms; Gastric mucosa; Gastroscopy; Submucosa; Stretching
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