Key factors for successful en bloc endoscopic submucosal dissection of early stage gastric cancer using an insulation-tipped diathermic knife.
OBJECTIVE
En bloc endoscopic mucosal resection (EMR) is presently considered to be the treatment of choice for endoscopically resectable early stage gastric cancer (EGC). Although a new EMR technique using an insulation-tipped diathermic knife (endoscopic submucosal dissection using an IT knife: IT knife-ESD) is reportedly suitable for en bloc resection, a failure in en bloc resection (piecemeal resection) can occur. We retrospectively analyzed factors affecting the success rate of en bloc resection by IT knife-ESD.


METHODS
A total of 71 gastric lesions were treated by IT knife-ESD. En bloc/piecemeal resection rates were investigated. Twelve potential factors associated with clinicopathological characteristics or procedures were analyzed univariately and multivariately.


RESULTS
IT knife-ESD was successfully performed in all 71 lesions. En bloc resection was achieved in 63 lesions (91%), while eight lesions (9%) were removed as two or more fragments (piecemeal resection). The multivariate analysis identified only one independent factor affecting the success rate of en bloc resection: the second-half period of procedure application. The en bloc resection rate was not associated with the tumor location/site, tumor size, specimen size, and ulceration within the tumor.


CONCLUSIONS
Much experience with IT knife-ESD may resolve the tumor-related technical difficulties. It is true for this advanced procedure that endoscopist experience is highly likely to be a critical factor for treatment success. We consider that IT knife-ESD for EGC is feasible and safe when performed by experienced endoscopists.
Abe
Nobutsugu
N
Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan. abenbtg@kyorin-u.ac.jp
Yamaguchi
Yasuharu
Y
Takeuchi
Hirohisa
H
Izumisato
Yumi
Y
Yanagida
Osamu
O
Masaki
Tadahiko
T
Mori
Toshiyuki
T
Sugiyama
Masanori
M
Atomi
Yutaka
Y
D000236:Adenoma / Q000601:surgery*; D000368:Aged; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D013525:Surgical Instruments