A novel treatment for early gastrointestinal carcinoma by ultrasonic endoscopic mucosal stripping.
OBJECTIVE
The aim of this study was to clarify the indications for a new endoscopic mucosal resection (EMR) technique that employs a cavitational ultrasonic surgical aspirator (CUSA). Endoscopic mucosal resection has proved an effective technique for treating early mucosal gastrointestinal cancer. However, resecting a lesion larger than 2 cm en bloc requires special devices and a long processing time; and it engenders the risk of bleeding, perforation, and other complications.


METHODS
We investigated application of the CUSA for detaching the mucosa from the muscularis propria of extracted porcine stomachs and then clarified the specification of an endoscopic ultrasonic scalpel for endoscopic mucosal resection by investigating characteristics of two original, handmade prototype cavitational ultrasonic surgical aspirators.


RESULTS
Use of a cavitational ultrasonic surgical aspirator should improve the ease and safety of detaching the mucosa. A small, high-power ultrasonic cylindrical vibrator should be developed to make possible a probe-type scalpel with a piezoelectric vibrator mounted in the tip of a catheter. An ultrasonic transmission-type scalpel could lead to the development of a new endoscopic mucosal resection device for clinical use.


CONCLUSIONS
The CUSA should enable us to develop a safer, simpler, time-saving scalpel for endoscopic mucosal resection, although some resolvable technical problems remain. The CUSA might enable us to diagnose carcinoma invasion into the submucosa in aspirated specimens and then aspirate out the entire invading submucosal carcinoma.
Division of Gastroenterology, Oji General Hospital, 3-4-8 Wakakusa-cho, Tomakomai, Hokkaido, 053-0021, Japan. hideohta@qjihosp.or.jp.
Hidetoshi
H
Ohta
Department of Gastroenterology, Sapporo National Hospital, Sapporo, Japan.
Naoaki
N
Shintani
Department of Gastroenterology, Sapporo National Hospital, Sapporo, Japan.
Koshi
K
Fujikawa
Department of Gastroenterology, Sapporo National Hospital, Sapporo, Japan.
Satoshi
S
Iyama
Department of Gastroenterology, Sapporo National Hospital, Sapporo, Japan.
Yasuo
Y
Takahashi
Division of Gastroenterology, Oji General Hospital, 3-4-8 Wakakusa-cho, Tomakomai, Hokkaido, 053-0021, Japan.
Atsushi
A
Nobuoka
Division of Gastroenterology, Oji General Hospital, 3-4-8 Wakakusa-cho, Tomakomai, Hokkaido, 053-0021, Japan.
Tadashi
T
Doi
Department of Diagnostic Ultrasound and Medical Electronics, Sapporo Medical University School of Medicine, Sapporo, Japan.
Tokiko
T
Nakamura
Department of Internal Medicine/Section Four, Sapporo Medical University School of Medicine, Sapporo, Japan.
Tetsuji
T
Takayama
Department of Diagnostic Ultrasound and Medical Electronics, Sapporo Medical University School of Medicine, Sapporo, Japan.
Hiroshi
H
Natori
early cancer; en bloc resection; endoscopic mucosal resection; endoscopic treatment; ultrasonic cavitation