Endosc Int Open 2015; 03(05): E425-E431
DOI: 10.1055/s-0034-1392567
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Genki Mori
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Satoru Nonaka
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Ichiro Oda
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Seiichiro Abe
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Haruhisa Suzuki
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Shigetaka Yoshinaga
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Takeshi Nakajima
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Yutaka Saito
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted 08 January 2015

accepted after revision 07 May 2015

Publication Date:
02 September 2015 (online)

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.