New MethodA new sinker-assisted endoscopic submucosal dissection for colorectal cancer
Section snippets
Estimation of the depth of invasion
High-magnification colonoscopy (PCF240ZI or GIF-Q240Z; Olympus Optical Co, Ltd, Tokyo, Japan) and chromoendoscopy with indigo carmine (0.2%) and crystal violet (0.05%) were used to estimate the depth of invasion.20, 21 In every lesion, a noninvasive Fujii crypt pattern22, 23, 24, 25 was observed, indicating that they were suitable for endoscopic resection. No biopsies were performed before any procedure.
Sinker system
The new method was approved by the ethical committee of our hospital, and written informed
Results
En bloc resection was achieved in all 4 cases. High-magnification chromocolonoscopy revealed no residual neoplastic tissue after ESD. The mean operating time was 100 minutes, and the individual operating times were 120, 150, 50, and 80 minutes for cases 1 to 4, respectively. Histopathologic evaluations revealed intramucosal cancer in cases 2 and 4, while tubular adenoma with moderate atypia and tubular adenoma with severe atypia were diagnosed in cases 1 and 3, respectively. All margins were
Discussion
EMR as an indication for superficial early GI cancer is accepted not only in Japan but also in Western countries, although prospective studies are still needed to compare EMR techniques with laparoscopic surgery for patients with early colonic cancer.3, 20, 30 This technique is not widely used for flat lesions >20 mm, however, in large part, because of its technical difficulty. To remove such lesions, we developed the IT knife,15 but complications resulting from IT EMR (ESD) frequently occur,
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