New technique for safer endoscopic submucosal dissection using the duodenal balloon occlusion method

Abstract

Our new technique has several advantages, including reduction in the frequency of postoperative abdominal symptoms, and will be useful and safe for gastric ESD.

Pure endoscopic full‐thickness resection with peritoneoscopy and omentectomy

“…Previous studies have reported that methods such as the duodenal balloon occlusion, the ESD, the double scope method and the equally spaced perforation method, which are used clinically in laparoscope‐supported hybrid NOTES, are extremely effective in pure NOTES animal experiments . The use of the duodenal balloon occlusion has been found to be highly efficacious in pure EFTR as well .…”

“…a). The amount of air put into the balloon was 60–70 mL, based on preoperative upper GI imaging examinations of healthy adults, which could reduce excessive dilatation of the GI tract and keep the surgical field clear. Two flexible endoscopes (Q260J, Olympus, Tokyo, Japan) were inserted transorally from the left and right pyriform sinuses, with one was used inside the stomach and the other to observe the surgery intra‐abdominally.…”

“…Flexible endoscopic treatment has advanced from polypectomy for small polyps to endoscopic mucosal resection (EMR) with local injections and the extremely low‐invasive endoscopic submucosal dissection (ESD) with electrosurgical knives which is made especially for flexible endoscopes. It recently became the standard treatment for early‐stage gastrointestinal (GI) tract cancer, and there have been various reports on derived techniques . In 2004, Kalloo et al .…”

Establishment of the hybrid endoscopic full-thickness resection of gastric gastrointestinal stromal tumors

“…Multi-center trials prior to the clinical acceptance of hybrid EFTR should therefore be conducted. The surgical procedure was designed to ensure incisional accuracy and excisional safety using the following steps: Setting the incision line according to the ESD method, using the double-scope technique to make and visualize the incision, creating the holes at equal distances from the abdominal wall (4) and using the duodenal balloon occlusion method (8). If hybrid EFTR is performed in accordance with these surgical procedures, LECS and hybrid EFTR may be established as less invasive, tailored surgical options.…”

“…The balloon was inserted into the duodenal bulb and inflated with 60-70 ml of air (using the duodenal balloon occlusion method) (Fig. 2B) (8). The esophagus and stomach were carefully lavaged with 2,000 ml of normal saline to disinfect the area in preparation for the full-thickness resection of the gastric wall (9).…”