High en bloc resection rate achieved by endoscopic mucosal resection with IT knife for early gastric cancer.
OBJECTIVE
Circumferential endoscopic mucosal resection (EMR) around lesions performed by an insulation-tipped diathermic knife (IT knife) increases en bloc resection rates, suggesting the possibility of expanding indications for EMR.


METHODS
Clinical outcome of EMR performed by IT knife under general anesthesia was evaluated for 26 patients with 29 early gastric cancer.


RESULTS
Successful en bloc resection rates obtained by the IT knife were 100, 87.5, 90.0 and 100% for lesions < or =10 mm in size, 11-20 mm, 21-30 mm, and > or =31 mm, respectively. They were significantly higher with the IT knife than those obtained by the conventional method (IT knife method: 93.1% vs. conventional method: 28.5%, p<0.0001). Two lesions were lateral margin positive, and in three cases invasion of lesions was observed as deep as the submucosa. Distal, total, and proximal gastrectomy with D2 lymphadenectomy, respectively, was provided in 3 cases; however, no lymph node involvement was found in any of the resected specimens. Bleeding and perforation were observed in 3 cases, respectively, however, no additional surgical treatment was required for these patients.


CONCLUSIONS
EMR by means of the IT knife under general anesthesia can be performed safely and adequately. It is a useful treatment modality for early gastric cancer.
Miyazaki
Shinichi
S
Department of Frontier Surgery (M9), Graduate School of Medicine, Chiba University, Chiba, Japan.
Gunji
Yoshio
Y
Aoki
Taito
T
Nakajima
Kouichi
K
Nabeya
Yoshihiro
Y
Hayashi
Hideki
H
Shimada
Hideaki
H
Uesato
Masaya
M
Hirayama
Nobuo
N
Karube
Tomoaki
T
Akai
Takashi
T
Nikaidou
Takashi
T
Kouzu
Teruo
T
Ochiai
Takenori
T
D000368:Aged; D004564:Electrocoagulation / Q000295:instrumentation*; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*