title: Gastric endoscopic submucosal dissection using sodium carboxymethylcellulose as a new injection substance.
abstract: OBJECTIVE
  To investigate the feasibility of endoscopic submucosal dissection (ESD) using sodium carboxymethylcellulose (SCMC) for gastric cancer.
  
  
  METHODS
  During October 2011 through April 2013, 98 lesions from 98 patients who underwent ESD using SCMC (ESD-SCMC) for early gastric cancer were enrolled in this study.　Two endoscopists, who had each performed fewer than 30 ESD procedures (less-experienced ESD physicians), performed ESD-SCMC under the supervision of two experts.　The primary outcome was the en bloc resection rate.　Secondary outcomes included the complete resection rate, the procedural time, the bleeding rate after SCMC injection, and complications.　Patient characteristics, time necessary for hemostasis after SCMC injection, rate of treatment completion by less-experienced ESD physicians alone, and the effects of SCMC during ESD and on resected specimens were also evaluated.
  
  
  RESULTS
  The en bloc resection rate was 100%.　Among these resections, 87.8% of the cases were completed by a less-experienced ESD physician alone.　The complete resection rate was 98.0%.　The mean total procedural time was 75.4 min.　The mean incidence of intraoperative bleeding following SCMC local injection was 1.7 times.　No bleeding was observed after SCMC injection in 29.6% of cases (29/98).　Five complications occurred: one case of microperforation (1.0%) and four cases of postoperative bleeding (4.0%).　SCMC remained in the submucosa.　The submucosa was readily manipulated when the deep submucosa was dissected, even after placing the specimen on a slide.
  
  
  CONCLUSIONS
  ESD-SCMC is feasible for the resection of early gastric cancer.
authors.affiliation: Department of Endoscopy, Fukushima Medical University Hospital.
authors.forename: Takuto
authors.initials: T
authors.lastname: Hikichi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Ko
authors.initials: K
authors.lastname: Watanabe
authors.forename: Jun
authors.initials: J
authors.lastname: Nakamura
authors.forename: Masaki
authors.initials: M
authors.lastname: Sato
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Takagi
authors.forename: Rei
authors.initials: R
authors.lastname: Suzuki
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sugimoto
authors.forename: Hitomi
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Naoki
authors.initials: N
authors.lastname: Konno
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Waragai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Asama
authors.forename: Mika
authors.initials: M
authors.lastname: Takasumi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ejiri
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Ohira
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Obara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002266:Carboxymethylcellulose Sodium / Q000008:administration & dosage*; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012042:Registries; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D002266:Carboxymethylcellulose Sodium