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DOI: 10.1055/a-1229-4280
Underwater endoscopic observation and mucosal resection for gastric protruding polyps
In an 82-year-old woman, two 20-mm polyps were identified at the greater curvature of the middle stomach body during esophagogastroduodenoscopy with a high-definition magnifying endoscope (GIF-H290Z, Olympus, Tokyo, Japan). Both lesions were in close contact with the stomach wall due to the influence of gravity, and their morphology could not be accurately determined ([Video 1], [Fig. 1a]). When underwater, however, the lesions floated up, the surface structure clearly separated, and the base was clearly recognizable ([Fig. 1b]). Both lesions were semi-pedunculated-type polyps. Magnifying endoscopy with narrow-band imaging showed an irregular microsurface pattern. Water pressure was also used to clearly identify the polyp base and the demarcation line of the base was clearly confirmed. The lesions were diagnosed as cancer. Changing the patient’s position, combination with the underwater method, also may have contributed to observation of the base of the lesions. Both lesions were resected with an electrosurgical snare while a negative margin was confirmed ([Fig. 1c]). Spurting bleeding occurred from the resected surface of the distal lesion, and the water was quickly aspirated to allow hemostasis with clipping. The pathological results showed that most of the proximal lesion was hyperplastic lesion and part well-differentiated adenocarcinoma, whereas the distal lesion was mostly intramucosal, well-differentiated adenocarcinoma. Both lesions had not lymphovascular invasion, and the lateral and vertical margins were cancer-free ([Fig. 2a], [Fig. 2b]).
Video 1 Underwater endoscopic observation and mucosal resection for gastric protruding polyps located on the greater curvature of the middle stomach.
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We previously reported that the water immersion technique is useful for observing the structure of polypoid lesions [1]. In this case, the method revealed the base of each lesion, thus allowing effective resection with a negative margin [2]. The underwater method was useful for observation and resection of large protruding lesions located on the greater curvature of the middle stomach.
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Competing interests
The authors declare that they have no conflict of interest.
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References
- 1 Sasaki S, Nishikawa J, Goto A. et al. Adenocarcinoma with tentacular processes (with video). Gastrointest Endosc 2017; 85: 852-853
- 2 Kono Y, Sakae H, Okada H. Underwater endoscopic mucosal resection for gastric polyp. Dig Endosc 2018; 30: 525
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Publication History
Article published online:
07 October 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Sasaki S, Nishikawa J, Goto A. et al. Adenocarcinoma with tentacular processes (with video). Gastrointest Endosc 2017; 85: 852-853
- 2 Kono Y, Sakae H, Okada H. Underwater endoscopic mucosal resection for gastric polyp. Dig Endosc 2018; 30: 525
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