Lee H, et al. - Researchers sought to determine how endoscopic submucosal dissection (ESD) affects subsequent laparoscopic radical gastrectomy procedures and to compare the surgical results of post-ESD patients with the control group using propensity score (PS) methods. They assessed 1,446 patients who underwent totally laparoscopic distal gastrectomy from 2013 to 2018. Of these, 107 patients underwent ESD before surgery (the ESD group). The patients who underwent gastrectomy earlier than 24 days after ESD had a longer operation time than the patients who did not. In addition, longer operation times and more intraoperative blood loss were reported among patients whose ulcer size, due to previous ESD, exceeded 4.6 cm vs those whose ulcer size was small. In the PS matching analysis, postoperative morbidity was more frequent among patients who underwent distal gastrectomy within 24 days after ESD vs non-ESD patients. These findings suggest that ESD after laparoscopic distal gastrectomy is mostly safe in terms of short-term surgical outcomes, however, the subsequent operation may become difficult when there is a short interval between the two procedures and a large ESD scar.