En bloc endoscopic mucosal resection of a large early stage gastric cancer by combined use of an insulation-tipped diathermic knife and a grasping forceps percutaneously inserted into the gastric lumen.
A new endoscopic mucosal resection using an insulation-tipped diathermic knife (IT knife-EMR) is a promising procedure for en bloc resection of an early stage gastric cancer. However, the use of this procedure for a large lesion on the greater curvature of the gastric middle-upper body is technically difficult. With the help of a grasping forceps percutaneously inserted into the gastric lumen, which allowed traction to be applied to the lesion, a 66-year-old man with a large tumor (49mm in diameter) on the greater curvature of the gastric middle body underwent IT knife-EMR. This approach enabled easy dissection between the submucosa and the muscle layer by the IT knife under direct vision. The lesion was completely removed as a single piece. This new technique, employing IT knife-EMR in cooperation with a percutaneously inserted grasping forceps, could be a potential procedure to make original IT knife-EMR easier. This approach may enhance the utility of original IT knife-EMR for selected tumors, that is, large tumors on the greater curvature of the middle-upper body of the stomach and/or ulcerated tumors. We propose that the present approach may provide an important alternative to laparoscopic intragastric surgery.
Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan. abenbtg@kyorin-u.ac.jp
Nobutsugu
N
Abe
Yumi
Y
Izumisato
Yasuharu
Y
Yamaguchi
Hisayo
H
Ueki
Osamu
O
Yanagida
Tadahiko
T
Masaki
Toshiyuki
T
Mori
Masanori
M
Sugiyama
Yutaka
Y
Atomi
D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D004564:Electrocoagulation / Q000295:instrumentation*; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*