title: Combined use of a magnifying endoscope with a narrow band imaging system and a multibending endoscope for en bloc EMR of early stage gastric cancer.
abstract: BACKGROUND
  En bloc EMR is performed in Japan as a curative treatment for early stage gastric cancer. However, current methods of EMR are technically difficult and require proficiency in determining the extent of the cancer. This study assessed the feasibility of a new method to obviate these problems and to facilitate en bloc EMR.
  
  
  METHODS
  The new method uses two types of endoscopes: a magnifying endoscope with a narrow band imaging system to enhance the definition of mucosal and microcirculatory structure, and an endoscope with multibending tip deflection to maintain orientation during EMR. Forty-two consecutive cases of mucosal gastric cancer treated by EMR were reviewed retrospectively. In 12 of these patients, 12 lesions that fulfilled guideline criteria for EMR were treated by the modified, en bloc EMR method of circumferential incision and snare resection by using the two endoscopes.
  
  
  RESULTS
  The rate of complete en bloc resection with the new method of EMR was 91.7%, (11/12). There was no major complication.
  
  
  CONCLUSIONS
  The new en bloc resection method for EMR with two endoscopes described here is feasible and may be a safe and a reliable technique for curative treatment of mucosal gastric cancer.
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakayoshi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kato
authors.forename: Takahiro
authors.initials: T
authors.lastname: Mashiko
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Uchiyama
authors.forename: Kenichi
authors.initials: K
authors.lastname: Goda
authors.forename: Shoryoku
authors.initials: S
authors.lastname: Hino
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuda
authors.forename: Keiko
authors.initials: K
authors.lastname: Mochizuki
authors.forename: Muneo
authors.initials: M
authors.lastname: Kawamura
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal; D004867:Equipment Design; D006801:Humans; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*