Risk of multiple early gastric cancers in a patient with precursor lesions and endoscopic surveillance for 7 years: A case report

RATIONALE: Severe mucosal atrophy or intestinal metaplasia is a risk factor for synchronous and metachronous intestinal gastric cancer. Magnifying endoscopy with narrow-band imaging was useful for assessing differentiated early gastric cancer (EGC). PATIENT CONCERNS: A 62-year-old Chinese female was diagnosed with 5 multiple EGCs or high-grade dysplasia (HGD) with endoscopic surveillance for 7 years. DIAGNOSES: Synchronous and metachronous multiple EGCs. INTERVENTIONS: Endoscopic submucosal dissection (ESD) with en bloc resection was performed for all 5 multiple lesions. The ESD specimens were pathologically diagnosed with adenocarcinoma confined to the mucosa or HGD. OUTCOMES: After endoscopy resection, no residual, recurrent, or synchronous lesions were detected by endoscopic surveillance after ESD. LESSONS: Long-term, meticulous endoscopic surveillance is needed to monitor risk factors associated with multiple EGCs in patients with severe mucosal atrophy or intestinal metaplasia despite successful Helicobacter pylori eradication.