Preliminary evaluation on cutting ability of the gastric mucosa by diode laser ablation to support the EMR method

We developed a new endoscopic method to incise the gastric mucosa by diode laser ablation to support the endoscopic mucosal resection (EMR) for large lesions. Submucosal injection of 1mg/ml indocyanine green (ICG) solution was used to absorb the diode laser light at the submucosa and protect the musclaris propriae. When we applied this method endoscopically to incise the canine gastric mucosa with non-contact method, we obtained circumferential incision and placed the snaring wire, although it was wide and blunt incision. However, we sometimes failed to cut the mucosa because of gastric movement and/or trangential irradiation and/or wide laser beam spot. With conical contract probe, continuous and sharp incision was obtained in most cases. Gastric movement and/or tangential irradiation made it difficult to gain stable cutting in some cases. By improving the laser probe tip and using the transparent hood, smooth cutting might be easily obtained. We think our laser incision method may be available to enhance the efficacy of EMR for large cancer lesion.