title: Novel technique of endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia.
abstract: Endoscopic submucosal dissection (ESD) for early stage gastric cancer (EGC) has improved the success rate of en bloc resection but results in perforation more often than does endoscopic mucosal resection. We report a novel technique of ESD using an external grasping forceps. A total of 265 lesions with EGC or gastric adenoma were enrolled in this study. Sixteen lesions were located in the upper third portion of the stomach, 114 in the middle third portion, and 135 in the lower third portion. After submucosal injection followed by circumcision of the lesions with a flex knife, the external grasping forceps was introduced with the help of a second grasping forceps and anchored at the margin of the lesion. Oral traction applied with this forceps could elevate the lesion and make the submucosal layer wider and more visible, thereby facilitating dissection of the submucosal layer under direct vision. The mean lesion size was 15.0 mm (range: 5-50 mm). All but 11 lesions (95.8%) could be resected en bloc with free margins. Mean procedure time was 45 min (range: 20-180 min). It was difficult to carry out this procedure when the lesions were located in the cardia, lesser curvature, or posterior wall of the upper third of the gastric body. Bleeding after ESD occurred in 10 patients (3.8%) and perforation occurred in one patient (0.4%). The endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia is efficacious and safe.
authors.affiliation: Center for Diagnostic and Therapeutic Endoscopy, Keio University Hospital, Shinjuku-ku, Tokyo, Japan. imaedahi@yahoo.co.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Imaeda
authors.forename: Naoki
authors.initials: N
authors.lastname: Hosoe
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ida
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kashiwagi
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Morohoshi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Suganuma
authors.forename: Shuichi
authors.initials: S
authors.lastname: Nagakubo
authors.forename: Koichi
authors.initials: K
authors.lastname: Komatsu
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Suzuki
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Saito
authors.forename: Koichi
authors.initials: K
authors.lastname: Aiura
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kumai
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; 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