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
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 08. Januar 2015

accepted after revision 07. Mai 2015

Publikationsdatum:
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.

 
  • References

  • 1 Gotoda T, Yanagisawa A, Sasako M et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
  • 2 Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
  • 3 Gotoda T, Yamamoto H, Soetikno R. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol 2006; 41: 929-942
  • 4 Soetikno R, Kaltenbach T, Yeh R et al. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 2005; 23: 4490-4498
  • 5 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
  • 6 Goto O, Fujishiro M, Kodashima S et al. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy 2009; 41: 118-122
  • 7 Chung IK, Lee JH, Lee SH et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 2009; 69: 1228-1235
  • 8 Gotoda T, Iwasaki M, Kusano C et al. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg 2010; 97: 868-871
  • 9 Ahn JY, Jung HY, Choi KD et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 2011; 74: 485-493
  • 10 Kosaka T, Endo M, Toya Y et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: A single-center retrospective study. Dig Endosc 2014; 26: 183-191
  • 11 Tanabe S, Ishido K, Higuchi K et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center. Gastric Cancer 2014; 17: 130-136
  • 12 Oda I, Oyama T, Abe S et al. Preliminary results of multicenter questionnaire study on long-term outcomes of curative endoscopic submucosal dissection for early gastric cancer. Dig Endosc 2014; 26: 214-219
  • 13 Oyama T, Kikuchi Y. Aggressive endoscopic mucosal resection in the upper GI tract – Hook knife EMR method. Minim Invasive Ther Allied Technol 2002; 11: 291-295
  • 14 Yamamoto H, Sekine Y, Higashizawa T et al. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate electrocautery incision forceps. Gastrointest Endosc 2001; 54: 629-632
  • 15 Oda I, Gotoda T, Hamanaka H et al. Endoscopic submucosal dissection for early gastric cancer: Technical feasibility, operation time and complication from a large consecutive series. Dig Endosc 2005; 17: 54-58
  • 16 Toyonaga T, Man-I M, Fujita T et al. The performance of a novel ball-tipped flush knife for endoscopic submucosal dissection: a case-control study. Aliment Pharmacol Ther 2010; 32: 908-915
  • 17 Nonaka S, Saito Y, Takisawa H et al. Safety of carbon dioxide insufflation for upper gastrointestinal tract endoscopic treatment of patients under deep sedation. Surg Endosc 2010; 24: 1638-1645
  • 18 Lee WS, Cho JW, Kim KJ et al. Technical issues and new devices of ESD of early gastric cancer. World J Gastroenterol 2011; 17: 3585-3590
  • 19 Sakurazawa N, Kato S, Fujita I et al. Supportive techniques and devices for endoscopic submucosal dissection of gastric cancer. World J Gastrointest Endosc 2012; 4: 231-235
  • 20 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-112
  • 21 Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14: 113-123
  • 22 Goto O, Fujishiro M, Kodashima S et al. Is it possible to predict the procedural time of endoscopic submucosal dissection for early gastric cancer?. J Gastroenterol Hepatol 2009; 24: 379-383
  • 23 Ahn JY, Choi KD, Choi JY et al. Procedure time of endoscopic submucosal dissection according to the size and location of early gastric cancers: analysis of 916 dissections performed by 4 experts. Gastrointest Endosc 2011; 73: 911-916
  • 24 Nagata S, Jin YF, Tomoeda M et al. Influential factors in procedure time of endoscopic submucosal dissection for gastric cancer with fibrotic change. Dig Endosc 2011; 23: 296-301
  • 25 Akasaka T, Nishida T, Tsutsui S et al. Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by Osaka university ESD study group. Dig Endosc 2011; 23: 73-77
  • 26 Oda I, Suzuki H, Nonaka S et al. Complications of gastric endoscopic submucosal dissection. Dig Endosc 2013; 25: 71-78
  • 27 Toyonaga T, Nishino E, Hirooka T et al. Intraoperative bleeding in endoscopic submucosal dissection in the stomach and strategy for prevention and treatment. Dig Endosc 2006; 18: 123-S127
  • 28 Suzuki H, Oda I, Sekiguchi M et al. Process of technical stabilization of gastric endoscopic submucosal dissection at the National Cancer Center in Japan. Turk J Gastroenterol 2014; 25: 619-623