It is well known that type 2 diabetes (T2DM) is dramatically improved after bariatric surgery, although the mechanisms have not been clearly identified. The skill required for gastric surgery for gastric cancer is very similar to that needed in bariatric surgery. In this study, we evaluated the immediate improvement of T2DM after gastrectomy for gastric cancer.

A total of nine patients who were diagnosed with early gastric cancer (EGC) and already had T2DM underwent a 75 g oral glucose tolerance test (OGTT) before surgery and within two weeks after gastrectomy. Glucose, insulin, and c-peptide were measured before, and 30 and 60 minutes after ingesting 75 g of glucose. From these trials, we calculated the HOMA-IR, insulinogenic index, Matsuda index, and area under the curve (AUC).

The mean age of participants was 57.23 ± 11.08 years and eight of them were men. HOMA-IR (4.2 vs. 2.3, P = 0.012) levels were decreased after surgery. There were no significant differences of insulinogenic index, fasting blood sugar before and after surgery. The Matsuda index (3.3 vs. 8.3, P = 0.002) was significantly increased and AUC (512.9 vs. 388.7 mg-hr/dL, P > 0.001) upon 75 g OGTT was significantly decreased after surgery.

Insulin sensitivity was immediately improved after gastrectomy for early gastric cancer in patients with T2DM.

Endoscopic resection(ER) is effective therapy on EGC and which is treated according to the histological diagnosis of forcep biopsy. But sometimes the histological diagnosis of forcep biopsy and post-ER does not match with each other and it might lead to wrong treatment. The aim of this study is to find the frequency of histologic differences between forcep biopsy and post-ER, and to confirm the characteristics of lesions which make errors.

We selected the confirmed cancer cases of 141 patients of 1359 gastric tumor lesions which were treated under the ER in Eulji university hospital from May 2005 to March 2013. They were sorted by the age and sex of patient, location of lesion, present of ulcer and depression to identify the discordance between forcep biopsy and ER. The discordant group was compared with non-cancer-diagnosed controlled group, retrospectively.

70 cases(5.5%) of 1283 cases of “cancer negative” in forceps biopsy were fo䴸nd to be diagnosed cancer on final diagnosis of cancer by post-ER result. In this discordant group showed characteristics of bigger size that are with more frequently in tumor size D15mm(17.9% vs. 31.4%, p=0.03), have depressed lesion(ᄀ 4.3% vs. 41.4%, p<0.01) and have 䴸lceration(2.4% vs.18.6%, p<0.01) than that of 84 control gro䴸p not diagnosed cancer.

In cases of tumor with size D15mm, presented with depressed lesion and ulceration, we should consider combined cancer, even the result of forcep biopsy was negative. Therefore, more careful and accurate resection should be taken with characters listed above.