Endoscopic Complete Removal of the Histologically Unconfirmed Gastric Cancer With Massive Invasion as a Giant Biopsy

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A 68-year-old man underwent upper GI endoscopy in a mass screening, which showed a suspicious tumor in the antral region of stomach. However, histologic examination of repeated endoscopic biopsy samples (15 samples) revealed no neoplastic change. Although all the examinations including endoscopy, endosonography, and barium study pointed to the diagnosis of gastric cancer, we did not have histologic evidence of malignancy. Hence, complete endoscopic removal of the lesion using a new method of endoscopic mucosal resection (EMR) was performed as a giant biopsy. Histologic assessment of the endoscopically resected specimen confirmed invasive adenocarcinoma of the stomach. He then underwent distal gastrectomy with regional lymphadenectomy. Endoscopic resection of the tumor in the digestive tract is also a very useful diagnostic modality of the lesion when malignancy cannot be revealed by endoscopic biopsy.

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