Endosonography during endoscopic mucosal resection to enhance its safety: a new technique.
BACKGROUND
We have performed endoscopic mucosal resection of the esophagus (172 cases), stomach (102 cases), and colon (28 cases) using a transparent plastic cap. Because the lesion-bearing mucosa is suctioned up inside the cap under endoscopic suction, the mucosa should be dissected sufficiently from the proper muscle layer to prevent perforation.


METHODS
To avert the risk of perforation, we introduced endosonographic assessment of submucosal dissection (47 cases). In all cases, just keeping the ultrasonic probe on the surface of the mucosa allowed us to evaluate whether the mucosal lesion was lifted up sufficiently from the proper muscle layer after local saline injection.


RESULTS
It was possible to confirm that the muscle layer was kept outside the strangulating snare by the same procedure (32 of 37 cases, 86.5%).


CONCLUSIONS
We experienced five muscular resections in cases without the ultrasonic probe and no muscular resection with the ultrasonic probe. Thus we recommend endosonographic assessment during endoscopic mucosal resection to enhance its safety.
Izumi
Y
Y
First Department of Surgery, Tokyo Medical and Dental University, 5-45, Yushima 1-chome, Bunkyo-ku, Tokyo, Japan.
Inoue
H
H
Kawano
T
T
Tani
M
M
Tada
M
M
Okabe
S
S
Takeshita
K
K
Endo
M
M
D003110:Colonic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D019160:Endosonography / Q000295:instrumentation; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000601:surgery; D009092:Mucous Membrane / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome