Novel technique of endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia: How i do it

Hiroyuki Imaeda, Naoki Hosoe, Yosuke Ida, Kazuhiro Kashiwagi, Yuichi Morohoshi, Kazuhiro Suganuma, Shuichi Nagakubo, Koichi Komatsu, Hidekazu Suzuki, Yoshimasa Saito, Koichi Aiura, Haruhiko Ogata, Yasushi Iwao, Koichiro Kumai, Yuko Kitagawa, Toshifumi Hibi

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Endoscopic submucosal dissection (ESD) for early stage gastric cancer (EGC) has improved the success rate of en bloc resection but results in perforation more often than does endoscopic mucosal resection. We report a novel technique of ESD using an external grasping forceps. A total of 265 lesions with EGC or gastric adenoma were enrolled in this study. Sixteen lesions were located in the upper third portion of the stomach, 114 in the middle third portion, and 135 in the lower third portion. After submucosal injection followed by circumcision of the lesions with a flex knife, the external grasping forceps was introduced with the help of a second grasping forceps and anchored at the margin of the lesion. Oral traction applied with this forceps could elevate the lesion and make the submucosal layer wider and more visible, thereby facilitating dissection of the submucosal layer under direct vision. The mean lesion size was 15.0 mm (range: 5-50 mm). All but 11 lesions (95.8%) could be resected en bloc with free margins. Mean procedure time was 45 min (range: 20-180 min). It was difficult to carry out this procedure when the lesions were located in the cardia, lesser curvature, or posterior wall of the upper third of the gastric body. Bleeding after ESD occurred in 10 patients (3.8%) and perforation occurred in one patient (0.4%). The endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia is efficacious and safe.

Original languageEnglish
Pages (from-to)122-127
Number of pages6
JournalDigestive Endoscopy
Volume21
Issue number2
DOIs
Publication statusPublished - 2009 Apr 1

Keywords

  • Early gastric cancer
  • Endoscopic submucosal dissection
  • Grasping forceps

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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