Endoscopy 2006; 38(10): 1007-1010
DOI: 10.1055/s-2006-925264
Original article
© Georg Thieme Verlag KG Stuttgart · New York

A New Technique for Endoscopic Submucosal Dissection for Early Gastric Cancer using an External Grasping Forceps

H.  Imaeda1 , Y.  Iwao2 , H.  Ogata1 , H.  Ichikawa2 , M.  Mori2 , N.  Hosoe2 , T.  Masaoka2 , M.  Nakashita2 , H.  Suzuki2 , N.  Inoue2 , K.  Aiura1 , H.  Nagata2 , K.  Kumai1 , T.  Hibi2
  • 1Center for Diagnostic and Therapeutic Endoscopy, Keio University Hospital, Tokyo, Japan
  • 2Dept. of Internal Medicine, School of Medicine, Keio, University, Tokyo, Japan
Further Information

Publication History

Submitted 27 October 2005

Accepted after revision 21 December 2005

Publication Date:
27 April 2006 (online)

Background and Study Aims: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has improved the success rate of en-bloc resection. We report here on a new technique using an external grasping forceps.
Patients and Methods: A total of 25 patients with suitable EGCs over 10 mm in diameter located in the gastric body were enrolled. After submucosal injection followed by circumcision of the lesion with a needle-knife, an external grasping forceps was introduced with the help of a second grasping forceps and anchored at the distal margin of the lesion. With gentle oral traction applied with this forceps, the lesion was dissected endoscopically in retroversion from the aboral side.
Results: The mean lesion size was 15.0 mm (range 10 - 25 mm). Using the technique described, all lesions could be resected en bloc with free margins. The mean procedure time was 45 min (range 30 - 80 minutes). No significant bleeding requiring blood transfusion or perforation occurred.
Conclusions: This technical modification may simplify and shorten the gastric ESD procedure, except for lesions in distal locations, without compromising the efficacy.

References

  • 1 Tada M, Murakami A, Karita M. et al . Endoscopic resection of early gastric cancer.  Endoscopy. 1993;  25 445-450
  • 2 Inoue H, Takeshita K, Hori H. et al . Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions.  Gastrointest Endosc. 1993;  39 58-62
  • 3 Matsushita M, Hajiro K, Okazaki K. et al . Endoscopic mucosal resection of gastric tumors located in the lesser curvature of the upper third of the stomach.  Gastrointest Endosc. 1997;  45 512-515
  • 4 Ohkuwa M, Hosokawa K, Boku A. et al . New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife.  Endoscopy. 2001;  33 221-226
  • 5 Ono H, Kondo H, Gotoda T. et al . Endoscopic mucosal resection for treatment of early gastric cancer.  Gut. 2001;  48 225-229
  • 6 Hirao M, Masuda K, Asanuma T. et al . Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine.  Gastrointest Endosc. 1988;  34 264-269
  • 7 Yamamoto H, Kawata H, Sunada K. et al . Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood.  Endoscopy. 2003;  35 690-694
  • 8 Kondo H, Gotoda T, Ono H. et al . Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer.  Gastrointest Endosc. 2004;  59 284-288
  • 9 Kobayashi T, Gotohda T, Tamakawa K. et al . Magnetic anchor for more effective endoscopic mucosal resection.  Jpn J Clin Oncol. 2004;  34 118-123
  • 10 Kume K, Yamasaki K, Kanda K. et al . Endoscopic submucosal dissection using a novel irrigation hood-knife.  Endoscopy. 2005;  37 1030-1031

H. Imaeda, M. D.

Center for Diagnostic and Therapeutic Endoscopy

Keio University Hospital · Shinanomachi 35 · Shinjuku-ku · Tokyo 160 - 8582 · Japan

Fax: +81-3-3353-3536

Email: imaedahi@yahoo.co.jp