title: Large early gastric cancers treated by endoscopic submucosal dissection with an insulation-tipped diathermic knife.
abstract: It is difficult to remove a large early gastric cancer (> or = 3 cm) in one-piece resection using conventional endoscopic mucosal resection. We tried to use an insulation-tipped (IT) diathermic knife to dissect these lesions. IT-endoscopic submucosal dissection (ESD) was performed in four aging patients with gastric malignancy. All lesions could be removed in one-piece resection by IT-ESD, although three of them exhibited remarkable fibrosis and ulceration. Three cases experienced curative treatment with IT-ESD after the pathologic evaluation, but it was not curative in one case because the pathology showed angiolymphatic invasion. This patient refused additional surgery in consideration of existing major systemic diseases. At 3 months to 1 year of follow-up, endoscopy showed no evidence of residual cancer. IT-ESD is effective in the treatment of large early gastric cancer and is an alternative treatment for early gastric cancer patients who are at risk for major operation.
authors: Division of Gastroenterology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
authors: Chun-Chao
authors: CC
authors: Chang
authors: Cheng
authors: C
authors: Tiong
authors: Chia-Lang
authors: CL
authors: Fang
authors: Shiann
authors: S
authors: Pan
authors: Jean-Dean
authors: JD
authors: Liu
authors: Horng-Yuan
authors: HY
authors: Lou
authors: Ching-Ruey
authors: CR
authors: Hsieh
authors: Sheng-Hsuan
authors: SH
authors: Chen
mesh_terms: D000368:Aged; D004564:Electrocoagulation; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*