title: Double-endoscope endoscopic submucosal dissection for the treatment of early gastric cancer accompanied by an ulcer scar (with video).
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) for early gastric cancer accompanied by an ulcer scar remains challenging. Several counter-traction techniques have been attempted to facilitate ESD, but a standard procedure remains to be established.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of double-endoscope ESD by using a single light source in patients with early gastric cancer accompanied by an ulcer scar.
  
  
  METHODS
  Single center, retrospective study.
  
  
  METHODS
  Kitasato University East Hospital.
  
  
  METHODS
  A total of 30 early gastric cancers with ulcer scars were treated by double-endoscope ESD in 30 patients from October 2008 through May 2012.
  
  
  METHODS
  Double-endoscope ESD.
  
  
  METHODS
  En bloc resection rate, complete resection rate, treatment time, and adverse events.
  
  
  RESULTS
  The use of two endoscopes for ESD provided a good field of vision and allowed counter-traction to be applied to the lesion, clearly facilitating submucosal dissection. Because only a single light source was used, the working space of the endoscope room was not compromised. Moreover, it was unnecessary to prepare another light source or to coordinate image filing. The en bloc resection rate and complete resection rate were 100% and 90%, respectively, and the median treatment time was 80 minutes. As compared with historical control data obtained before the introduction of double-endoscope ESD, the rate of cutting into the specimen was significantly lower (7% vs 35%; P = .01). No serious adverse events occurred during the procedure. Postoperatively, however, 3 patients (10%) had delayed hemorrhage, and 1 (3.3%) had a delayed perforation.
  
  
  CONCLUSIONS
  Single-center, nonrandomized study.
  
  
  CONCLUSIONS
  Our experience indicates that our procedure for double-endoscope ESD is useful and feasible in patients with early gastric cancer accompanied by an ulcer scar.
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Higuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tanabe
authors.forename: Mizutomo
authors.initials: M
authors.lastname: Azuma
authors.forename: Tohru
authors.initials: T
authors.lastname: Sasaki
authors.forename: Chikatoshi
authors.initials: C
authors.lastname: Katada
authors.forename: Kenji
authors.initials: K
authors.lastname: Ishido
authors.forename: Akira
authors.initials: A
authors.lastname: Naruke
authors.forename: Tetuo
authors.initials: T
authors.lastname: Mikami
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002921:Cicatrix / Q000150:complications; D004210:Dissection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D020699:Gastroscopes; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications; D016896:Treatment Outcome
keywords: APC; ESD; M; SM1; SM2; argon plasma coagulation; deeper submucosal invasion (≥500 μm below the muscularis mucosae); endoscopic submucosal dissection; minute submucosal invasion (<500 μm below the muscularis mucosae); mucosal invasion