title: Endoscopic submucosal dissection combined with endoscopic injection sclerotherapy for early gastric cancer on gastric fundal varices.
abstract: Currently, there is little report of treatment strategy for early gastric cancer (EGC) on gastric fundal varices (GFVs), because controlling GFVs was more challenging than controlling gastric cardiac varices associated with esophageal varices. We first report effective endoscopic treatment of EGC on GFVs of a 77-year-old man with Child-B cirrhosis. Endoscopic ultrasound and multidetector-row computed tomography studies revealed intramucosal EGC on variceal components, supplied from posterior gastric vein and drained to subphrenic vein without gastrorenal shunt. With informed consent, we performed endoscopic submucosal dissection (ESD) after eradication of GFVs by endoscopic injection sclerotherapy (EIS). Histologic assessment revealed curability of ESD and inflammation and fibrosis around EIS site. Thereafter, no recurrence and complication had occurred. To avoid life-threatening bleeding from GFVs, we achieved complete resection by ESD under direct visualization of submucosa after eradication of GFVs by EIS based on the examination of hemodynamics and local relationship between EGC and GFVs.
authors.affiliation: Division of Gastroenterology, Tohoku University Hospital, Sendai, Miyagi, Japan. kaname@wa2.so-net.ne.jp
authors.forename: Kaname
authors.initials: K
authors.lastname: Uno
authors.forename: Katsunori
authors.initials: K
authors.lastname: Iijima
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Koike
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Abe
authors.forename: Naoki
authors.initials: N
authors.lastname: Asano
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yokosawa
authors.forename: Akira
authors.initials: A
authors.lastname: Imatani
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D003131:Combined Modality Therapy; D003487:Cyanoacrylates / Q000008:administration & dosage; D004210:Dissection / Q000379:methods; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005748:Gastric Fundus / Q000601:surgery*; D005753:Gastric Mucosa / Q000601:surgery; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D015552:Injections, Intralesional; D007479:Iopamidol / Q000008:administration & dosage; D008297:Male; D009829:Oleic Acids / Q000008:administration & dosage; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D015911:Sclerotherapy / Q000379:methods; D013274:Stomach Neoplasms / Q000628:therapy*
chemical_list: D003487:Cyanoacrylates; D009829:Oleic Acids; D012597:Sclerosing Solutions; D007479:Iopamidol; C033343:ethanolamine oleate