Optimal Timing of Pre-operative Endoscopic Clipping for Determining the Resection Line for Laparoscopy-assisted Distal Gastrectomy: Experience with 92 Gastrectomies for Early Gastric Cancer

Objective: Pre-operative endoscopic clipping for determining the resection line in patients with early gastric cancer (EGC) has been used safely, and its efficacy has been demonstrated. However, the optimal timing of endoscopic clipping for determining the resection line in EGC patients undergoing laparoscopy-assisted distal gastrectomy (LADG) has not been investigated. Methods: A retrospective analysis of 92 patients with EGC who underwent gastric resection after endoscopic clipping at OOO Hospital, Korea was performed. We analyzed the clinical and endoscopic features of patients, number of clips, time from clipping to surgery, and number of patients showing detachment of clips from the gastric wall before surgery. Patients were categorized into the following 2 groups: group A included patients whose clips were applied within 1 day before surgery and group B included patients whose clips were applied more than 1 day before surgery. Results: Of the 92 patients, 56 were in group A and 36 were in group B. In 11 patients (12.0%, 5 in group A and 6 in group B, P=0.329), the clips were detached from the gastric wall before surgery. The mean time from clipping to surgery did not differ significantly between the detached and non-detached groups (11 patients, mean 4.6 ± 4.6 days vs. 81 patients, mean 3.0 ± 4.0 days, P = 0.227). Conclusion: The timing of endoscopic clipping for the localization of tumors in EGC patients undergoing gastrectomy is not important for determining the resection line.