Negative Histology after Endoscopic Resection: An Endoscopist’s Aspect

Endoscopic submucosal dissection (ESD) is accepted as the standard treatment for gastric epithelial dysplasia or early gastric cancer because it enables curative en bloc resection and complete histopathological assessment of the specimen. However, occasionally, a tumorous lesion may not be detected, and histopathological discrepancies can occur after ESD. Reportedly, the prevalence of negative histopathological results after endoscopic resection is 2.0∼4.4%. Negative histopathological results after endoscopic resection are commonly attributable to complete removal of the lesion via an endoscopic forceps biopsy (EFB) at the time of the initial diagnostic endoscopic examination, an initial histopathological overestimation of the EFB specimen, and incorrect localization of the original tumor with subsequent ESD performed at a wrong site. A small tumor size and surface area are known to be significant endoscopic predictors of negative histopathological results after ESD. Therefore, clinicians should be mindful of the fact that negative histopathological findings observed after endoscopic resection warrant a comprehensive review of all pre-ESD data and an adequate follow-up to determine the cause of these findings and to detect any possibility of local recurrence.