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(EAM) procedure is simple and requires no special endoscope [1± 5]. However, delayed bleeding may occur from a gas− tric ulcer after EAM. If this problem is solved, day surgery may be possible. We have therefore developed a novel endo− scopic aspiration mucosectomy and clo− sure (EAMC) hood that facilitates the EAM procedure, simultaneously allowing endoscopic closure. We have recently developed a two−chan− nel prelooped hood that was constructed by drilling two side holes in the cap por− tion of a conventional prelooped soft hood (D−206−02~06, Olympus, Tokyo, Ja− pan); after this an irrigation tube and an accessory channel were attached [5]. The EAMC hood was produced by attaching an additional hood of short length and an another accessory channel to the top of the two−channel prelooped hood (l" Fig− ure 1). Then, two types of snares are set. The crescent−shaped snare (SD−221L−25, Olympus) is inserted through the acces− sory channel tube of the first part of the hood, and prelooped into the groove of the rim of the hood. The detained snare (HX−20L−1, Olympus) is passed through and tightened around the outer circum− ference of the second part of the hood. The EAMC procedure using the EAMC hood is carried out as follows (l" Fig− ure 2). After marking the periphery of the lesion and injecting saline solution into the submucosa, we placed the EAMC hood at the tip of the endoscope. Aspira− tion was released and the hood was then used to aspirate the lesion by high−power vacuum into the hood. We confirmed as− piration of the lesion with the outside CCD camera, and then snared the lesion using the detained and crescent−shaped snares. We used the former to tightly strangle the lesion, and resected the le− sion by means of blend electrosurgical current closing the latter snare. Two specimens were resected in an ani− mal model (pigs). The average diameter of the resected specimens was 15 mm.

Endoscopic aspiration mucosectomy and closure assisted by outside CCD camera