title: New technique for safer endoscopic submucosal dissection using the duodenal balloon occlusion method.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) enables complete, collective removal of gastrointestinal (GI) malignant tumors, but requires a long operation time. Air insufflated during ESD is distributed throughout the entire GI tract, and thus causes an enlarged feeling of the abdomen. We aimed to reduce the incidence of an enlarged feeling of the abdomen by wedging a balloon in the bulbus duodeni to reduce air flow into the lower parts of the GI tract.
  
  
  METHODS
  Sixteen patients who were approved by the institutional ethics committee and provided consent to participate in this single-center, prospective study were divided into two groups using a sealed-envelope randomization method: ESD with a balloon wedged in the bulbus duodeni (the balloon [+] group) or conventional ESD with no balloon (the balloon [-] group). Total air volume in the entire GI tract and its change before and after ESD were measured objectively by 3-D computed tomography.
  
  
  RESULTS
  In the balloon (+) group, the mean intestinal gas volume (± standard deviation) was 274.3 ± 142.0 mL before ESD, and 352.5 ± 183.2 mL after, with a mean change of 78.1 ± 139.7 mL. The increase in intestinal gas volume was well controlled. No postoperative complications, such as an enlarged feeling of the abdomen, was reported in the balloon (+) group.
  
  
  CONCLUSIONS
  Our new technique has several advantages, including reduction in the frequency of postoperative abdominal symptoms, and will be useful and safe for gastric ESD.
authors: Department of Gastroenterology and Neurology, Kagawa Medical University School of Medicine, Kagawa, Japan. hiro4884@med.kagawa-u.ac.jp
authors: Hirohito
authors: H
authors: Mori
authors: Hideki
authors: H
authors: Kobara
authors: Hideyuki
authors: H
authors: Inoue
authors: Mitsuyoshi
authors: M
authors: Kobayashi
authors: Akemi
authors: A
authors: Muramatsu
authors: Takako
authors: T
authors: Nomura
authors: Jian
authors: J
authors: Gong
authors: Masanobu
authors: M
authors: Hagiike
authors: Kunihiko
authors: K
authors: Izuishi
authors: Yasuyuki
authors: Y
authors: Suzuki
authors: Tsutomu
authors: T
authors: Masaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects; D016009:Chi-Square Distribution; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D004384:Duodenoscopy / Q000009:adverse effects; D004386:Duodenum / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007564:Japan; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome