Efficacy of Clinical Pathway for the Management of Mucosal Gastric Carcinoma Treated with Endoscopic Submucosal Dissection Using an Insulated-tip Diathermic Knife

Abstract

Objective Recently, the cases of early gastric carcinomas which can be treated by endoscopic submucosal dissection (ESD) method have been increasing in our institute. Simple and precise guidelines for treating mucosal gastric carcinoma are necessary for improving the treatment outcome of this disease. In our institute, ESD using an insulated-tip diathermic knife (IT-ESD) was introduced for the treatment of mucosal gastric carcinoma in 1996. The purpose of this study was to evaluate the impact of a clinical pathway and standardize the treatment for mucosal gastric carcinoma treated with IT-ESD.Materials and Methods The Clinical Pathway and standardized of treatment for mucosal gastric carcinoma treated with IT-ESD were introduced at our institute in January 2002. We compared the length of hospitalization, total costs, hospital costs, operation time and bleeding rate during the 18 months before and after January 2002.Results There was no significant difference in the clinical characteristics of the 20 patients in the control group and the 23 patients in the pathway group. There were 9 and 13 bleeding cases in the respective groups. The mean length of hospitalization, total costs and hospital costs were significantly less for patients in the pathway group. There was no significant difference in the operation time or bleeding rate among the two groups.Conclusion Our clinical pathway and the standardization of treatment for mucosal gastric carcinoma treated with IT-ESD proved effective for treating patients with mucosal gastric carcinoma and for minimizing the length of hospitalization without compromising patient care.

Treatment of gastric remnant cancer post distal gastrectomy by endoscopic submucosal dissection using an insulation-tipped diathermic knife

“…To achieve cure by EMR, one-piece resection is optimal for all lesions because it may reduce the local recurrence rate [10,29] . IT-ESD is a useful new endoscopic mucosal resection (EMR) method, which has recently become widespread in Japan due to its high one-piece resection rates [3,11,13,[15][16][17] . Few reports have described the results of IT-ESD for gastric remnant cancers in comparison with the usual strip biopsy method (conventional EMR).…”

“…IT-knife has a ceramic ball at the top of the incising needle knife [11,12,[19][20][21] to prevent perforation of the gastric wall. IT-ESD was performed as previously described using a single-channel endoscope [3,12,14,17,22] . Marks were made at several points along the outline of the lesion with a coagulation current, and saline containing 0.0025% epinephrine was injected just outside the marks to prevent perforation until the mucosa around the lesion was raised.…”

“…Nozaki et al [1] described that the gastric remnants of 457 cases post distal gastrectomy due to gastric cancers were surveyed periodically by endoscopic examination, and 10 patients (2.2%) were diagnosed as having gastric remnant cancer within 12 years. Endoscopic submucosal dissection (ESD) techniques using a variety of knives, such as the insulation-tipped diathermic knife (IT-knife), hook knife, needle knife, or flex knife, have been developed in Japan [2][3][4][5][6][7][8][9][10] and high one-piece resection rates have been reported for the treatment of mucosal malignancies [3,[11][12][13][14][15][16][17] . The remnant stomach post distal gastrectomy has narrow spaces.…”

Treatment of Elderly Patients with Early Gastric Cancer by Endoscopic Submucosal Dissection Using an Insulated-tip Diathermic Knife

“…Endoscopic submucosal dissection (ESD) techniques using a variety of knives, such as the insulated-tip diathermic knife (IT-knife), hook knife or flex knife, have been developed in Japan (2, 3) and high onepiece resection rates have been reported (1,3). The number of elderly patients with EGC has steadily been increasing, however, there has been no report describing the result and feasibility of the ESD using an insulated-tip diathermic knife (IT-ESD) for the elderly patients with EGC.…”

Minimally Invasive Surgery of Gastric Cancer

“…Recently, many reports showed the superiority of endoscopic submucosal dissection (ESD) compared with endoscopic mucosal resection in terms of higher en bloc and complete resection rate [94][95][96] , and this new technique and the advance of devices allowed to extend the indication of endoscopic resection, which included mucosal cancer without ulcerative findings regardless of tumor size or mucosal cancer with ulcerative findings less than 3 cm, or submucosal invasive cancer (less than 500 μm from the muscularis mucosae) less than 3 cm [97][98][99][100] .…”