Case StudyEndoscopic submucosal dissection with insulated-tip knife for large mucosal early gastric cancer: a feasibility study (with videos)
Section snippets
Patients and methods
This was a prospective case series study performed at an endoscopy unit at the Osaka Medical Center for Cancer and Cardiovascular Disease. An endoscopist (N.U.) who has experienced 7800 EGDs and 180 conventional EMRs performed all procedures.
Observations
Between July 2002 and December 2004, 95 patients with EGC larger than 3 cm presented to our center. Of them, 32 patients who were diagnosed as having submucosal EGC, 23 patients with intramucosal EGC with ulcer or scar, and 10 patients with undifferentiated-type mucosal EGC underwent gastrectomy. Thus, a total of 30 consecutive patients were enrolled (Fig. 2). Characteristics of the subjects are shown in Table 1. We divided the 30 patients into 3 groups of 10 (1st, 2nd, and 3rd) to assess the
Discussion
In this case series study, we demonstrated the technical feasibility of ESD for large intramucosal EGC with the IT knife. The possibility for cure from large intramucosal EGC by endoscopic resection could be demonstrated by complete removal of the tumor and assurance of a lack of lymph-node metastasis by histologic examination. En bloc resection is not absolutely necessary for complete removal of the tumor but is strongly preferred to piecemeal resection for elimination of local recurrence and
References (22)
- et al.
Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions
Gastrointest Endosc
(1993) - et al.
A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms
Gastrointest Endosc
(2002) - et al.
Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection
Gastrointest Endosc
(2006) - et al.
Successful endoscopic en bloc resection of a large laterally spreading tumor in the rectosigmoid junction by endoscopic submucosal dissection
Gastrointest Endosc
(2006) - et al.
Effectiveness of premedication with pronase for improving visibility during gastroendoscopy: a randomized controlled trial
Gastrointest Endosc
(1998) - et al.
The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm
Gastrointest Endosc
(2005) - et al.
Endoscopic ultrasonography and endoscopy for staging depth of invasion in early gastric cancer: a pilot study
Gastrointest Endosc
(1997) - et al.
Clinical impact of strip biopsy for early gastric cancer
Gastrointest Endosc
(2004) - et al.
Endoscopic submucosal dissection of early esophageal cancer
Clin Gastroenterol Hepatol
(2005) - et al.
Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar
Gastrointest Endosc
(2006)