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Novel strategy of endoscopic submucosal dissection using an insulation-tipped knife for early gastric cancer: near-side approach method.

Mori G, Nonaka S, Oda I, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Saito Y - Endosc Int Open (2015)

Bottom Line: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives) to treat gastric lesions located on the greater curvature of the gastric body remains technically challenging because of the associated bleeding, control of which can be difficult and time consuming.We reviewed patients who underwent ESD for solitary early gastric cancer located on the greater curvature of the gastric body from January 2003 to September 2014.Although, the procedure time required by an experienced endoscopist was not significantly different between the two groups (100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure time for a less-experienced endoscopist (90 vs. 120 minutes).

View Article: PubMed Central - PubMed

Affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

ABSTRACT

Background and study aims: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives) to treat gastric lesions located on the greater curvature of the gastric body remains technically challenging because of the associated bleeding, control of which can be difficult and time consuming. To eliminate these difficulties, we developed a novel strategy which we have called the "near-side approach method" and assessed its utility.

Patients and methods: We reviewed patients who underwent ESD for solitary early gastric cancer located on the greater curvature of the gastric body from January 2003 to September 2014. The technical results of ESD were compared between the group treated with the novel near-side approach method and the group treated with the conventional method.

Results: This study included 238 patients with 238 lesions, 118 of which were removed using the near-side approach method and 120 of which were removed using the conventional method. The median procedure time was 92 minutes for the near-side approach method and 120 minutes for the conventional method. The procedure time was significantly shorter in the near-side approach method arm. Although, the procedure time required by an experienced endoscopist was not significantly different between the two groups (100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure time for a less-experienced endoscopist (90 vs. 120 minutes).

Conclusions: The near-side approach method appears to require less time to complete gastric ESD than the conventional method using IT knives for technically challenging lesions located on the greater curvature of the gastric body, especially if the procedure is performed by less-experienced endoscopists.

No MeSH data available.


Related in: MedlinePlus

 Conventional method using IT knife. a An initial incision is made with Needle knife on the far (oral) side of the field of retroflex view. b A circumferential mucosal incision is performed with IT knife/IT knife-2 from the far (oral) to the near (anal) side. c Submucosal dissection is performed with IT knife/IT knife-2.
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FI211-3:  Conventional method using IT knife. a An initial incision is made with Needle knife on the far (oral) side of the field of retroflex view. b A circumferential mucosal incision is performed with IT knife/IT knife-2 from the far (oral) to the near (anal) side. c Submucosal dissection is performed with IT knife/IT knife-2.

Mentions: High-frequency knives used in gastric ESD are broadly classified as either insulation-tipped knives (IT knives) or needle-type knives. The IT knife was developed by Ono et al. at the National Cancer Center Hospital in the late 1990 s and has been used during ESD since the initial development of the procedure 2 (Fig. 1). The needle-type knives were developed around the same time 1314 (Fig. 2). Because of the technical differences between these two types of knife, different approaches are used in gastric ESD. Tissue is incised and dissected by pulling the IT knife, but by pushing with the needle-type knife. Using a needle-type knife, the endoscopist begins mucosal incision and submucosal dissection at the near side of the field of view and proceeds toward the far side. In contrast, when using an IT knife, the endoscopist begins by making the initial incision at the far side of the field of view, makes mucosal incisions from the far to the near side, and then, following a circular incision, proceeds to perform the submucosal dissection (Fig. 3). This strategy has been established and spread widely as the standard method of gastric ESD using the IT knife (conventional method). Gastric ESD can be performed successfully in most areas of the stomach with the conventional method using the IT knife at our institution. However, when dissecting lesions on the greater curvature of the gastric body, the control of bleeding is often difficult and time consuming, especially during mucosal incision. Using the IT knife and pulling from the far to the near side makes the field of work blind in the case of bleeding. Thus, it is difficult to see precisely the bleeding points without enlarging the masked incision which may cause new bleeding (Video 1).


Novel strategy of endoscopic submucosal dissection using an insulation-tipped knife for early gastric cancer: near-side approach method.

Mori G, Nonaka S, Oda I, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Saito Y - Endosc Int Open (2015)

 Conventional method using IT knife. a An initial incision is made with Needle knife on the far (oral) side of the field of retroflex view. b A circumferential mucosal incision is performed with IT knife/IT knife-2 from the far (oral) to the near (anal) side. c Submucosal dissection is performed with IT knife/IT knife-2.
© Copyright Policy
Related In: Results  -  Collection

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FI211-3:  Conventional method using IT knife. a An initial incision is made with Needle knife on the far (oral) side of the field of retroflex view. b A circumferential mucosal incision is performed with IT knife/IT knife-2 from the far (oral) to the near (anal) side. c Submucosal dissection is performed with IT knife/IT knife-2.
Mentions: High-frequency knives used in gastric ESD are broadly classified as either insulation-tipped knives (IT knives) or needle-type knives. The IT knife was developed by Ono et al. at the National Cancer Center Hospital in the late 1990 s and has been used during ESD since the initial development of the procedure 2 (Fig. 1). The needle-type knives were developed around the same time 1314 (Fig. 2). Because of the technical differences between these two types of knife, different approaches are used in gastric ESD. Tissue is incised and dissected by pulling the IT knife, but by pushing with the needle-type knife. Using a needle-type knife, the endoscopist begins mucosal incision and submucosal dissection at the near side of the field of view and proceeds toward the far side. In contrast, when using an IT knife, the endoscopist begins by making the initial incision at the far side of the field of view, makes mucosal incisions from the far to the near side, and then, following a circular incision, proceeds to perform the submucosal dissection (Fig. 3). This strategy has been established and spread widely as the standard method of gastric ESD using the IT knife (conventional method). Gastric ESD can be performed successfully in most areas of the stomach with the conventional method using the IT knife at our institution. However, when dissecting lesions on the greater curvature of the gastric body, the control of bleeding is often difficult and time consuming, especially during mucosal incision. Using the IT knife and pulling from the far to the near side makes the field of work blind in the case of bleeding. Thus, it is difficult to see precisely the bleeding points without enlarging the masked incision which may cause new bleeding (Video 1).

Bottom Line: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives) to treat gastric lesions located on the greater curvature of the gastric body remains technically challenging because of the associated bleeding, control of which can be difficult and time consuming.We reviewed patients who underwent ESD for solitary early gastric cancer located on the greater curvature of the gastric body from January 2003 to September 2014.Although, the procedure time required by an experienced endoscopist was not significantly different between the two groups (100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure time for a less-experienced endoscopist (90 vs. 120 minutes).

View Article: PubMed Central - PubMed

Affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

ABSTRACT

Background and study aims: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives) to treat gastric lesions located on the greater curvature of the gastric body remains technically challenging because of the associated bleeding, control of which can be difficult and time consuming. To eliminate these difficulties, we developed a novel strategy which we have called the "near-side approach method" and assessed its utility.

Patients and methods: We reviewed patients who underwent ESD for solitary early gastric cancer located on the greater curvature of the gastric body from January 2003 to September 2014. The technical results of ESD were compared between the group treated with the novel near-side approach method and the group treated with the conventional method.

Results: This study included 238 patients with 238 lesions, 118 of which were removed using the near-side approach method and 120 of which were removed using the conventional method. The median procedure time was 92 minutes for the near-side approach method and 120 minutes for the conventional method. The procedure time was significantly shorter in the near-side approach method arm. Although, the procedure time required by an experienced endoscopist was not significantly different between the two groups (100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure time for a less-experienced endoscopist (90 vs. 120 minutes).

Conclusions: The near-side approach method appears to require less time to complete gastric ESD than the conventional method using IT knives for technically challenging lesions located on the greater curvature of the gastric body, especially if the procedure is performed by less-experienced endoscopists.

No MeSH data available.


Related in: MedlinePlus