Endoscopic submucosal dissection for early gastric cancer using a cross-counter technique.
OBJECTIVE
Endoscopic submucosal dissection (ESD) in early gastric cancer has rapidly come into widespread use. However, since complications such as bleeding and perforation often occur, and the procedure time is longer for ESD than endoscopic mucosal resection (EMR), development of safer and more reliable technique is required.


METHODS
The subjects comprised 45 patients with lesions diagnosed histologically as early gastric cancer. They were divided into three groups: cross-counter technique group (CC, n = 15), peroral traction-assisted ESD with suture material group (PT, n = 15), and no-traction group (NT, n = 15). ESD was carried out by two endoscopists who had experienced fewer than 30 cases of ESD. To compare safety and efficacy of a new traction method (CC group) for ESD in early gastric cancer with other methods (PT group and NT group), procedure time, dissected area per unit time, complete resection rate, perforation rate, and bleeding rate were evaluated.


RESULTS
There was no significant difference among these three groups in terms of complications, complete resection rate or procedure time. The dissection area per unit time was 22.4, 15.7, and 13.5 mm(2)/min in the CC, PT, and NT groups, respectively, and there was a significant difference between the CC and NT groups (p = 0.007).


CONCLUSIONS
The cross-counter technique shortened the treatment time for endoscopists without abundant experience in gastric ESD, and it is considered a useful method to institute in order to introduce ESD.
Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Koichi
K
Okamoto
Seisuke
S
Okamura
Naoki
N
Muguruma
Shinji
S
Kitamura
Tetsuo
T
Kimura
Yoshitaka
Y
Imoto
Hiroshi
H
Miyamoto
Toshiya
T
Okahisa
Tetsuji
T
Takayama
D000368:Aged; D000369:Aged, 80 and over; D061345:Early Medical Intervention; D004867:Equipment Design; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery; D020699:Gastroscopes; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*