Residual gastric cancer above the suture line that was successfully resected en bloc by ESD

A male in his 70s had undergone pyloric gastrectomy for gastric cancer more than 20 years ago. Endoscopy was performed for postoperative follow-up of the gastric cancer, and a 25 mm IIc lesion was found on the suture line of the residual gastric lesser curvature. Biopsy showed a well-differentiated adenocarcinoma (tub1). Endoscopic submucosal dissection (ESD) was performed under general anesthesia. The dissection proceeded to the layer where we could recognize the staple was removed. The lesion was resected en bloc. The pathological findings were 25×24 mm, tub1, SM1 (350 μm), ly0, v0, HM0, VM0.