Endoscopic Mucosal Resection for Early Gastric Cancer: Aiming at Safety, Speed, and Reliability

Abstract

We assessed the non‐marginating surgical techniques of endoscopic mucosal resection (EMR) for early gastric cancer, represented by the ‘double‐channel’ method and the suction method, and the marginating surgical techniques, represented by the ‘insulation tip’ (IT) and the ‘endoscopic resection with high saline epinephrine’ (ERHSE) methods, and reviewed cases in the literature and our own cases from the standpoint of complications and duration of therapy with each method. Bleeding occurred in 3.6–4.5% of the cases treated by the non‐marginating surgical techniques and 17% of the cases treated by the marginating surgical techniques. Perforation occurred in only 0.3% of the cases treated by the non‐marginating surgical techniques, as opposed to 6.7% of the cases treated by the marginating surgical techniques. The results of EMR with a new type of therapeutic scope, the multi‐bending scope, showed that it was useful for obtaining a direct en face view of the lesser curvature of the body of the stomach, and an increase in the rate of one‐time complete resection was seen when it was used.

Endoscopic submucosal dissection for residual/local recurrence of early gastric cancer after endoscopic mucosal resection

“…EMR is a standard treatment for early gastric cancer, as it pro− vides an effective alternative to open surgery with the benefits of reduced invasiveness and lower costs [18]. However, there have been few reports on the treatment of local recurrences of early gastric cancer after EMR.…”

Endoskopische Tumortherapie beim Magenfrühkarzinom - Möglichkeiten und Grenzen

“…Es handelt sich überwiegend um Blutungen und Perforationen. Die Blutungsinzidenz liegt bei den ESD-Verfahren zwischen 1,7 bis 22 % [7,24,40,41] und damit höher, als bei der konventionellen EMR [10,35]. Zwei Zentren haben ihr Kollektiv zum Methodenvergleich retrospektiv überprüft.…”

“…In der konventionellen EMR-Gruppe wird eine Blutungsinzidenz von 4,5 % bzw 4 % versus 17 % bzw. 22 % in der ESD-Gruppe angegeben [7,24]. Als Risikofaktor bei der ESD gelten großflächige Tumoren und im proximalen Magen lokalisierte Läsionen.…”

“…Die Perforationshäufigkeit bei der ESD reicht von 0 % bis 7 % [7,19,24,40,41]. Die Perforationen im Rahmen der EMR-Techniken liegen überwiegend unter 1 % [10,24,29,35].…”

Clinical Evaluation of the Multi‐bending Scope in Various Endoscopic Procedures of the Upper Gi Tract

“…The development of new endoscopes and treatment devices has made possible novel methods of endoscopic diagnosis and treatment that would have been inconceivable in the past. Among these technological innovations, one in particular, the multi‐bending scope (M‐Scope), has been attracting a lot of attention as it not only enables observation and biopsies of sites that are difficult to approach with conventional scopes, but is also expected to be useful for endoscopic treatments such as endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) of early gastric cancer and endoscopic hemostasis of gastric bleeding 1,2 . However, because the M‐Scope is still in the prototype stage, various aspects of the design need to be improved and problems remain to be solved.…”