Endoscopic Submucosal Dissection Using a Newly Developed Endoscopic Hood for Gastric Tumors

Takeuchi Hirohisa, Abe Nobutsugu, Ohki Atsuko, Yanagida Osamu, Masaki Tadahiko, Mori Toshiyuki, Sugiyama Masanori, Atomi Yutaka. Department of Surgery, Kyorin University School of Medicine


Background and Aims: Endoscopic submucosal dissection (ESD) of gastric tumors has improved the success rate of en bloc resection but is still technically difficult for large, ulcerated, or intramuscle lesions. To make ESD of such lesions easier, we developed a new technique using a newly designed endoscopic hood. The hood has a structure in which an outer sheath can easily be attached and detached. The outer sheath can allow a grasping forceps to pass; therefore, the grasping forceps can be safely introduced into the stomach and the lesion can be resected with traction applied with this forceps. We report here on a new technique of ESD using the new hood.
Patients: Eight patients underwent ESD using the new hood and the external grasping forceps. The patients were six men and two women with a mean age of 77 years. The pathological diagnoses were early-stage gastric cancer (n = 6) and gastrointestinal stromal tumor (n = 2).
Technique: After submucosal injection followed by circumcision of the lesion with a needle knife and/or insulation-tipped knife, an external grasping forceps was introduced via the outer sheath into the stomach and anchored at the distal or proximal margin of the lesion. After detaching the external grasping forceps from the hood by moving the endoscope tip, the lesion was endoscopically dissected with gentle traction using this forceps.
Results: By the technique described, we were able to resect all the lesions en bloc with tumor-free margins. The traction using the external grasping forceps provided a good view of the dissection plane in each patient and thus made the dissection easier. The mean lesion size and procedure time were 29 (range 15 to 70) mm and 145 (range 76 to 300) minutes, respectively. Although a perforation occurred in one patient, the patient was treated conservatively. The mean duration of the postoperative hospital stay was 8 (range 6 to15) days.
Conclusions: This technical modification can make the gastric ESD procedure easier.

Session Number: SS14 – Therapeutic Endoscopy
Program Number: S082

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