Endoscopic submucosal dissection for early gastric cancer using the tip of an electrosurgical snare (thin type)

Abstract

Background : Although the strip biopsy method and aspiration method are popular endoscopic mucosal resection techniques for its convenience and reliability, they have limitations in resectable tumor size and location. Endoscopic submucosal dissection techniques using the diathermic needle knife or the insulated-tip diathermic knife have been introduced to overcome this disadvantage, but they have high risks for bleeding and perforation. Therefore, we have developed a new endoscopic submucosal dissection technique using the tip of an electrosurgical snare (thin type) and assessed its efficacy. Methods : Fifty-nine lesions with differentiated-type gastric cancer without ulceration were treated with our technique at the University Hospital. The tip of an electrosurgical snare (thin type) was used for mucosal incision and submucosal dissection as a flexible diathermic knife. Results : The size of tumor was 5-85 mm in diameter (mean size: 29 mm) and the location varied from cardia to antrum. Among 59 lesions, 56 lesions (56/59, 95%) were resected completely in an en-bloc fashion with much less perforation (2/ 59, 3.4%) and bleeding (1/59, 1.7%) regardless of their size and location. Conclusion : New endoscopic submucosal dissection technique using the tip of an electrosurgical snare (thin type) is safe and reliable. We were able to resect early gastric cancer with a much higher en-bloc resection rate and fewer complications using this technique.

Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer

“…Following the introduction of the IT-OM, many other devices have been reported for ESD [6][7][8]. While these devices were shown to have both advantages and disadvantages, the IT-OM remained superior in terms of operating time.…”

Endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms

“…By mixing in a small amount of dye, the sodium hyaluronate can be easily distinguished from the non-injected area; (3) mucosal incision: a mucosal incision around the lesion is then made with an electrosurgical knife. Several knives have been developed for this purpose, such as the insulation-tip knife [34,35] , hook knife [24,36] , flex knife [37,38] , flush knife [39] , ball-tipped flush knife [40] and triangle-tipped knife [41] . Usually, the distal half of the mucosal incision is completed first, followed by the proximal half; and (4) submucosal dissection: dissection of the submucosa proceeds from the proximal to the distal end, using the same knife that was used for the mucosal incision.…”

Preventive effects of etodolac, a selective cyclooxygenase‐2 inhibitor, on cancer development in extensive metaplastic gastritis, a Helicobacter pylori‐negative precancerous lesion

“…[21][22][23][24][25][26] All patients were inhabitants from around the Wakayama area. In Japan, where the incidence of gastric cancer is high, treatment of mucosal gastric cancer without lymph node metastasis is usually achieved with endoscopic resection, preserving the stomach.…”