title: High en bloc resection rate achieved by endoscopic mucosal resection with IT knife for early gastric cancer.
abstract: 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.
authors.affiliation: Department of Frontier Surgery (M9), Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Gunji
authors.forename: Taito
authors.initials: T
authors.lastname: Aoki
authors.forename: Kouichi
authors.initials: K
authors.lastname: Nakajima
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nabeya
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimada
authors.forename: Masaya
authors.initials: M
authors.lastname: Uesato
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hirayama
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Karube
authors.forename: Takashi
authors.initials: T
authors.lastname: Akai
authors.forename: Takashi
authors.initials: T
authors.lastname: Nikaidou
authors.forename: Teruo
authors.initials: T
authors.lastname: Kouzu
authors.forename: Takenori
authors.initials: T
authors.lastname: Ochiai
mesh_terms: 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*