Limits...
Successful treatment of early gastric cancer adjacent to a fundal varix by endoscopic submucosal dissection and endoscopic cyanoacrylate therapy.

Kim YS, Cho WY, Cho JY, Jin SY - Clin Endosc (2012)

Bottom Line: A disadvantage of ESD is its technical difficulty, which requires advanced skills and is associated with a higher rate of complications.The two lesions were so close together that treatment was not easy.The lesions were managed successfully with a combination of ESD and EVO using cyanoacrylate.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.

ABSTRACT
Endoscopic submucosal dissection (ESD) was developed for the en bloc resection of large early gastrointestinal neoplasms. A disadvantage of ESD is its technical difficulty, which requires advanced skills and is associated with a higher rate of complications. Endoscopic variceal obturation (EVO) using cyanoacrylate has emerged as the initial treatment of choice for acute gastric variceal bleeding. This procedure achieves hemostasis in 90% of cases. A 52-year-old patient with Child A alcoholic liver cirrhosis presented with early gastric cancer in the cardia and type 1 isolated gastric varices in the fundus. The two lesions were so close together that treatment was not easy. The lesions were managed successfully with a combination of ESD and EVO using cyanoacrylate.

No MeSH data available.


Related in: MedlinePlus

Endoscopic submucosal dissection of the early gastric cancer (EGC) showing the EGC and treated varix before (A) endoscopic submucosal dissection, (B) the incision with muscle exposure, (C) the incision above the varix, and (D) a large artificial ulcer after the resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3401623&req=5

Figure 3: Endoscopic submucosal dissection of the early gastric cancer (EGC) showing the EGC and treated varix before (A) endoscopic submucosal dissection, (B) the incision with muscle exposure, (C) the incision above the varix, and (D) a large artificial ulcer after the resection.

Mentions: In this case, the surgical option was a total gastrectomy, due to the location of the lesion. However, the patient decided against surgical treatment and ESD was chosen. Treatment priority was given to the fundal varix to prevent bleeding during the ESD (Fig. 2). Endoscopic therapy with tissue adhesive was used. Typically, 2 mL of a 1:1 mixture of cyanoacrylate (B. Braun, Tuttlingen, Germany) and Lipiodol (Guerbet, Aulnay-sous-Bois, France) was administered. After 2 weeks, Doppler endosonography showed absence of blood flow in the varix. Then, ESD was performed with a forward-viewing endoscope (EG 2990i; Pentax, Tokyo, Japan) (Fig. 3). Prophylactic blood transfusion of platelets or fresh frozen plasma was not performed before ESD. After making several marking dots outside the lesion with a dual knife (KD-650Q; Olympus, Tokyo, Japan), ESD was performed with the dual knife and an insulated-tip diathermic knife (KD-611L; Olympus). When a circumferential incision was made around the varices, no bleeding was seen. The submucosal dissection was performed in forced coagulation mode (VIO 300D; ERBE, Tübingen, Germany). Precoagulation of the submucosal vessels with a Coagrasper (FD-410LR; Olympus) was used to prevent severe bleeding. The en bloc resection was accomplished with a total procedure time of 90 minutes. Histology revealed a moderately differentiated adenocarcinoma measuring 24×12 mm size with disease-free margins (Fig. 4A). The depth of submucosal invasion was 150 µm, with no lymphovascular invasion (Fig. 4B). Follow-up endoscopy demonstrated a healing ulcer with no evidence of recurrence 2 months after the ESD (Fig. 5).


Successful treatment of early gastric cancer adjacent to a fundal varix by endoscopic submucosal dissection and endoscopic cyanoacrylate therapy.

Kim YS, Cho WY, Cho JY, Jin SY - Clin Endosc (2012)

Endoscopic submucosal dissection of the early gastric cancer (EGC) showing the EGC and treated varix before (A) endoscopic submucosal dissection, (B) the incision with muscle exposure, (C) the incision above the varix, and (D) a large artificial ulcer after the resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3401623&req=5

Figure 3: Endoscopic submucosal dissection of the early gastric cancer (EGC) showing the EGC and treated varix before (A) endoscopic submucosal dissection, (B) the incision with muscle exposure, (C) the incision above the varix, and (D) a large artificial ulcer after the resection.
Mentions: In this case, the surgical option was a total gastrectomy, due to the location of the lesion. However, the patient decided against surgical treatment and ESD was chosen. Treatment priority was given to the fundal varix to prevent bleeding during the ESD (Fig. 2). Endoscopic therapy with tissue adhesive was used. Typically, 2 mL of a 1:1 mixture of cyanoacrylate (B. Braun, Tuttlingen, Germany) and Lipiodol (Guerbet, Aulnay-sous-Bois, France) was administered. After 2 weeks, Doppler endosonography showed absence of blood flow in the varix. Then, ESD was performed with a forward-viewing endoscope (EG 2990i; Pentax, Tokyo, Japan) (Fig. 3). Prophylactic blood transfusion of platelets or fresh frozen plasma was not performed before ESD. After making several marking dots outside the lesion with a dual knife (KD-650Q; Olympus, Tokyo, Japan), ESD was performed with the dual knife and an insulated-tip diathermic knife (KD-611L; Olympus). When a circumferential incision was made around the varices, no bleeding was seen. The submucosal dissection was performed in forced coagulation mode (VIO 300D; ERBE, Tübingen, Germany). Precoagulation of the submucosal vessels with a Coagrasper (FD-410LR; Olympus) was used to prevent severe bleeding. The en bloc resection was accomplished with a total procedure time of 90 minutes. Histology revealed a moderately differentiated adenocarcinoma measuring 24×12 mm size with disease-free margins (Fig. 4A). The depth of submucosal invasion was 150 µm, with no lymphovascular invasion (Fig. 4B). Follow-up endoscopy demonstrated a healing ulcer with no evidence of recurrence 2 months after the ESD (Fig. 5).

Bottom Line: A disadvantage of ESD is its technical difficulty, which requires advanced skills and is associated with a higher rate of complications.The two lesions were so close together that treatment was not easy.The lesions were managed successfully with a combination of ESD and EVO using cyanoacrylate.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.

ABSTRACT
Endoscopic submucosal dissection (ESD) was developed for the en bloc resection of large early gastrointestinal neoplasms. A disadvantage of ESD is its technical difficulty, which requires advanced skills and is associated with a higher rate of complications. Endoscopic variceal obturation (EVO) using cyanoacrylate has emerged as the initial treatment of choice for acute gastric variceal bleeding. This procedure achieves hemostasis in 90% of cases. A 52-year-old patient with Child A alcoholic liver cirrhosis presented with early gastric cancer in the cardia and type 1 isolated gastric varices in the fundus. The two lesions were so close together that treatment was not easy. The lesions were managed successfully with a combination of ESD and EVO using cyanoacrylate.

No MeSH data available.


Related in: MedlinePlus