Endoscopic mucosal resection using electro-surgical snare for early gastric cancer - Submucosal dissection method

Uno, A.; Yamaguchi, T.; Yokoyama, K.; Ohnishi, M.; Nakajoh, T.; Akai, Y.; Watanabe, T.; Siota, J.; Uehara, T.; Ohtani, T.; Ogihara, A.; Nakajima, N.; Kohashi, E.; Iwasaki, A.; Arakawa, Y.; Kinukawa, N.

Nichidai Igaku Zasshi 62(9): 486-490


ISSN/ISBN: 0029-0424
Accession: 034850673

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Submucosal dissection is one of the EMR methods, and useful for resction of lesions in the lump. In this procedure, the mucosa around the lesion is cut, and the submucosa is dissected using a needle knife, IT knife, fooking knife, or electrosurgical snare (a thin type). Especially, the electro-surgical snare (a thin type) is flexible, easy to use, and is relatively safe for avoiding perforation. Our method is comprised of several steps. First, we place markings around the lesion, and sodium hyaluronate is injected into the submucosal layer. Then electro-surgical snare (a thin type) is used for cutting around the lesion and exfoliating the lesion from the submucosal layer. In the present study, we describe submucosal dissections using a thin type of electro-surgical snare in three cases of early gastric cancers. Case I comprised a 10 x 5 mm Ilc lesion at the anterior wall of the gastric angulus. Case 2 comprised a 17 x 18 mm IIa + IIb lesion at the lesser curvature of the lower body of the stomach. Case 3 comprised a 60 x 35 mm IIa lesion at the anterior of the antrum. The lesions were completely resected in one piece. Histological findings for all three cases showed well differenciated adenocarcinoma, and the cancer lesion in each cases was limited to within the gastric mucosa. There were no malignant invasions into the vessels. After the resection, their were no postoperative complications such as bleeding or perforation. We concluded that submucosal dissection is as useful as complete resection for large lesions and for lesions that are difficult to remove using the standard EMR method.