title: Endoscopic submucosal tunnel dissection salvage technique for ulcerative early gastric cancer.
abstract: Endoscopic submucosal dissection is an effective treatment modality for early gastric cancer (EGC), though the submucosal fibrosis found in ulcerative EGC is an obstacle for successful treatment. This report presents two cases of ulcerative EGC in two males, 73- and 80-year-old, with severe fibrosis. As endoscopic ultrasonography suggested that the EGCs had invaded the submucosal layer, the endoscopic submucosal tunnel dissection salvage technique was utilized for complete resection of the lesions. Although surgical gastrectomy was originally scheduled, the two patients had severe coronary heart disease, and surgeries were refused because of the risks associated with their heart conditions. The endoscopic submucosal tunnel dissection salvage technique procedures described in these cases were performed under conscious sedation, and were completed within 30 min. The complete en bloc resection of EGC using endoscopic submucosal tunnel dissection salvage technique was possible with a free resection margin, and no other complications were noted during the procedure. This is the first known report concerning the use of the endoscopic submucosal tunnel dissection salvage technique salvage technique for treatment of ulcerative EGC. We demonstrate that endoscopic submucosal tunnel dissection salvage technique it is a feasible method showing several advantages over endoscopic submucosal dissection for cases of EGC with fibrosis.
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Hyuk Soon
authors.initials: HS
authors.lastname: Choi
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Min Ho
authors.initials: MH
authors.lastname: Seo
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.affiliation: Hyuk Soon Choi, Hoon Jai Chun, Min Ho Seo, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Yoon Tae Jeen, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Ho Sang Ryu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D016292:Procedural Sedation; D003327:Coronary Disease / Q000150:complications; D004210:Dissection / Q000379:methods*; D019160:Endosonography; D005355:Fibrosis; D005743:Gastrectomy / Q000379:methods*; D005753:Gastric Mucosa / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D013274:Stomach Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Early gastric cancer; Endoscopic submucosal dissection; Endoscopic submucosal tunnel dissection; Endoscopy; Fibrosis
references.citation: Endoscopy. 2012 Mar;44(3):231-5
references.pmid: 22354823
references.citation: J Gastroenterol. 2006 Oct;41(10):929-42
references.pmid: 17096062
references.citation: Endoscopy. 2012 Mar;44(3):225-30
references.pmid: 22354822
references.citation: World J Gastroenterol. 2011 Jun 7;17(21):2592-6
references.pmid: 21677825
references.citation: Endoscopy. 2010 Apr;42(4):265-71
references.pmid: 20354937
references.citation: Surg Endosc. 2011 Jun;25(6):1985-93
references.pmid: 21136092
references.citation: Gastrointest Endosc. 2013 Aug;78(2):266-73
references.pmid: 23472995
references.citation: Dig Liver Dis. 2012 Nov;44(11):925-9
references.pmid: 22824834
references.citation: Gastrointest Endosc. 2012 Jul;76(1):59-66
references.pmid: 22726467