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NOVEL TECHNIQUE OF ENDOSCOPIC SUBMUCOSAL DISSECTION USING AN EXTERNAL GRASPING FORCEPS FOR SUPERFICIAL GASTRIC NEOPLASIA
Author(s) -
Imaeda Hiroyuki,
Hosoe Naoki,
Ida Yosuke,
Kashiwagi Kazuhiro,
Morohoshi Yuichi,
Suganuma Kazuhiro,
Nagakubo Shuichi,
Komatsu Koichi,
Suzuki Hidekazu,
Saito Yoshimasa,
Aiura Koichi,
Ogata Haruhiko,
Iwao Yasushi,
Kumai Koichiro,
Kitagawa Yuko,
Hibi Toshifumi
Publication year - 2009
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2009.00842.x
Subject(s) - medicine , forceps , endoscopic submucosal dissection , perforation , lesion , surgery , endoscopic mucosal resection , dissection (medical) , submucosa , curvatures of the stomach , stomach , endoscopy , materials science , punching , metallurgy
Endoscopic submucosal dissection (ESD) for early stage gastric cancer (EGC) has improved the success rate of en bloc resection but results in perforation more often than does endoscopic mucosal resection. We report a novel technique of ESD using an external grasping forceps. A total of 265 lesions with EGC or gastric adenoma were enrolled in this study. Sixteen lesions were located in the upper third portion of the stomach, 114 in the middle third portion, and 135 in the lower third portion. After submucosal injection followed by circumcision of the lesions with a flex knife, the external grasping forceps was introduced with the help of a second grasping forceps and anchored at the margin of the lesion. Oral traction applied with this forceps could elevate the lesion and make the submucosal layer wider and more visible, thereby facilitating dissection of the submucosal layer under direct vision. The mean lesion size was 15.0 mm (range: 5–50 mm). All but 11 lesions (95.8%) could be resected en bloc with free margins. Mean procedure time was 45 min (range: 20–180 min). It was difficult to carry out this procedure when the lesions were located in the cardia, lesser curvature, or posterior wall of the upper third of the gastric body. Bleeding after ESD occurred in 10 patients (3.8%) and perforation occurred in one patient (0.4%). The endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia is efficacious and safe.