尽管每年进行内镜检查，但近端胃切除术 (PG) 后患有异时性残胃癌 (MRGC) 的患者有时不符合内镜切除术 (ER) 的条件。本研究旨在阐明 ER 不适用的临床危险因素。我们回顾了 2006 年至 2015 年间 203 例因 cT1 胃癌接受 PG 的患者的记录。残胃被分类为假穹窿、胃体或胃窦。32 例 MRGC在 29 名患者中被鉴定出。 20 个 MRGC 被分类为 ER（ER 组，62.5%），而 12 个 MRGC 不是（非 ER 组，37.5%）。 ER 组中 MRGC 位于假穹窿 1 例、语料库 5 例、胃窦 14 例；非 ER 组 MRGC 位于假穹窿 6 例、语料库 4 例、胃窦 2 例（P= 0.019）。多因素分析显示假性穹窿是非ER的独立危险因素（P=0.014）。在非 ER 组中，假穹窿处的 MRGC（n=6）具有更常见的未分化型组织学（4/6 与 0/6）、更深（≥pT1b2；6/6 与 2/6）和淋巴结转移（3/6 vs. 0/6）高于非假性穹窿病变（n=6）。我们在 MRGC 检测前一年通过年度随访内窥镜检查检查了发生 MRGC 的区域的可见性。在假穹窿的七个病变中，由于食物残留，只有两个（28.6%）的可见度得到保证。在非假性穹窿的 25 个病灶中，21 个病灶的可见性得到保证（84%；P=0.010）。内窥镜可见性增加了 ER 适用的机会。需要进行特殊准备，以确保完全清除假穹窿中的食物残渣。版权所有 © 2024。韩国胃癌协会。

Despite annual endoscopy, patients with metachronous remnant gastric cancer (MRGC) following proximal gastrectomy (PG) are at times ineligible for endoscopic resection (ER). This study aimed to clarify the clinical risk factors for ER inapplicability.We reviewed the records of 203 patients who underwent PG for cT1 gastric cancer between 2006 and 2015. The remnant stomach was categorized as a pseudofornix, corpus, or antrum.Thirty-two MRGCs were identified in the 29 patients. Twenty MRGCs were classified as ER (ER group, 62.5%), whereas 12 were not (non-ER group, 37.5%). MRGCs were located in the pseudo-fornix in 1, corpus in 5, and antrum in 14 in the ER group, and in the pseudo-fornix in 6, corpus in 4, and antrum in 2 in the non-ER group (P=0.019). Multivariate analysis revealed that the pseudo-fornix was an independent risk factor for non-ER (P=0.014). In the non-ER group, MRGCs at the pseudo-fornix (n=6) had more frequent undifferentiated-type histology (4/6 vs. 0/6), deeper (≥pT1b2; 6/6 vs. 2/6) and nodal metastasis (3/6 vs. 0/6) than non-pseudo-fornix lesions (n=6). We examined the visibility of the region developing MRGC on an annual follow-up endoscopy one year before MRGC detection. In seven lesions at the pseudofornix, visibility was only secured in two (28.6%) because of food residues. Of the 25 lesions in the non-pseudo-fornix, visibility was secured in 21 lesions (84%; P=0.010).Endoscopic visibility increases the chances of ER applicability. Special preparation is required to ensure the complete clearance of food residues in the pseudo-fornix.Copyright © 2024. Korean Gastric Cancer Association.