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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

 Chronological trend of the gastric ESD strategy. Since 2007, use of the near-side approach method has gradually increased, while use of the conventional method has decreased in our hospital.
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FI211-5:  Chronological trend of the gastric ESD strategy. Since 2007, use of the near-side approach method has gradually increased, while use of the conventional method has decreased in our hospital.

Mentions: At the start of the procedure, an initial marking was made around the lesion. Saline with indigo carmine and epinephrine, or a mixture of saline and sodium hyaluronate (MucoUp; Johnson & Johnson Co., Ltd, Tokyo, Japan), was locally injected into the submucosa. ESD procedures for lesions located on the greater curvature of the gastric body must be performed in retroflex view. Therefore, the oral side of the lesion corresponds to the far side of the field of view, and the anal side corresponds to the near side. The procedures for making an initial incision and a mucosal incision differ between the conventional and near-side approach methods. In the conventional method, an initial incision is made on the far side of the field of retroflex view (Fig. 3 a), mucosal incision is performed with an IT knife/IT knife-2 from the far to the near side (Fig. 3 b), and a circular incision is made to accomplish submucosal dissection (Fig. 3 c). In the near-side approach method, initial incisions are made on the lateral side of the lesion and a mucosal incision is made with an IT knife/IT knife-2 for about one-third or one-half of the circumference on the near side of the field of view (Fig. 4 a-1). Alternatively, a Dual knife is used to make a mucosal incision on the near side of the field of view (Fig. 4 a-2). Then, submucosal dissection with an IT knife/IT knife-2 is begun on the near side (Fig. 4 b), the circular mucosal incision is completed, and the remaining submucosal dissection is performed (Fig. 4 c). Any bleeding is managed using forced coagulation with ESD knives or soft coagulation with hemostatic forceps (Hot biopsy; Boston Scientific Co., Ltd, Tokyo, Japan, Coagrasper; Olympus). The near-side approach method has been gradually introduced from 2007 (Fig. 5). The ESD procedure time was defined as the time from the beginning of marking to lesion removal.


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)

 Chronological trend of the gastric ESD strategy. Since 2007, use of the near-side approach method has gradually increased, while use of the conventional method has decreased in our hospital.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612249&req=5

FI211-5:  Chronological trend of the gastric ESD strategy. Since 2007, use of the near-side approach method has gradually increased, while use of the conventional method has decreased in our hospital.
Mentions: At the start of the procedure, an initial marking was made around the lesion. Saline with indigo carmine and epinephrine, or a mixture of saline and sodium hyaluronate (MucoUp; Johnson & Johnson Co., Ltd, Tokyo, Japan), was locally injected into the submucosa. ESD procedures for lesions located on the greater curvature of the gastric body must be performed in retroflex view. Therefore, the oral side of the lesion corresponds to the far side of the field of view, and the anal side corresponds to the near side. The procedures for making an initial incision and a mucosal incision differ between the conventional and near-side approach methods. In the conventional method, an initial incision is made on the far side of the field of retroflex view (Fig. 3 a), mucosal incision is performed with an IT knife/IT knife-2 from the far to the near side (Fig. 3 b), and a circular incision is made to accomplish submucosal dissection (Fig. 3 c). In the near-side approach method, initial incisions are made on the lateral side of the lesion and a mucosal incision is made with an IT knife/IT knife-2 for about one-third or one-half of the circumference on the near side of the field of view (Fig. 4 a-1). Alternatively, a Dual knife is used to make a mucosal incision on the near side of the field of view (Fig. 4 a-2). Then, submucosal dissection with an IT knife/IT knife-2 is begun on the near side (Fig. 4 b), the circular mucosal incision is completed, and the remaining submucosal dissection is performed (Fig. 4 c). Any bleeding is managed using forced coagulation with ESD knives or soft coagulation with hemostatic forceps (Hot biopsy; Boston Scientific Co., Ltd, Tokyo, Japan, Coagrasper; Olympus). The near-side approach method has been gradually introduced from 2007 (Fig. 5). The ESD procedure time was defined as the time from the beginning of marking to lesion removal.

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