Endoscopic mucosal resection (EMR) is a widely used and less invasive alternative
to open surgery for early gastric cancer. The benefits include preservation of the
stomach, noninvasiveness, and shorter hospital stays. In addition, the technique is
indicated for lesions in which there is minimal risk of lymph-node involvement. Before
the procedure, endoscopic marking of the tissue is very important to ensure a tumor-free
margin and complete resection; in Japan, the marking is usually carried out with a
needle-knife (Olympus KD-1L-1) [1]. The needle-knife is also used for precut procedures and mucosal incision for circumferential
mucosal resection [2]
[3]. Argon plasma coagulation (APC) is a recently introduced therapeutic technique in
the digestive tract, used to treat hemorrhagic and neoplastic lesions. Its advantages
include effective and safe coagulation, controllable coagulation depth, a noncontact
operating mode, and axial, radial, and retrograde application [4]. To avoid the risk of perforation during endoscopic marking with the needle-knife,
we investigated the safety of APC and tested the use of the technique to create circumferential
marks around early gastric cancer lesions before EMR. To the best of our knowledge,
this is the first report of the use of APC for endoscopic marking before EMR. In a
pilot study, we found that APC is safe and useful for carrying out endoscopic marking
for EMR. In addition, APC combined with the use of a needle-knife also allows different
types of mark to be made, making it much easier to differentiate the distal margin
from the proximal margin in the retrieved resected specimens (Figures [1], [2]). Our group is currently conducting a prospective study to evaluate the safety and
usefulness of this technique in a large number of patients. Research for this report
was supported in part by a Grant-in-Aid for Cancer Research (12 - 4) from the Japanese
Ministry of Health, Labor, and Welfare.
Endoscopy_UCTN_Code_CPL_1AM_2AZ
Figure 1 Markings around the 15 mm gastric cancer were made by APC on the distal side and by
a needle knife on the proximal side, both giving quite a different macroscopic appearance
(a in vivo, b on the specimen).
Figure 2 Histological differences between the two types of thermal injury: APC injury was limited
to the mucosa and more uneven (a) than with the needle-knife (b).
