Transnasal endoscope-assisted endoscopic submucosal dissection for gastric adenoma and early gastric cancer in the pyloric area: a case series

Endoscopic submucosal dissection (ESD) is an important therapeutic option for gastric adenoma and early gastric cancer (EGC). However, ESD is technically difficult when lesions are located in the pyloric area. Our aim was to introduce the transnasal endoscope-assisted ESD method, which provides for excellent cutting-line visualization through control of submucosal traction. A total of eight patients with gastric adenoma or EGC located in the pyloric area were consecutively enrolled. A primary operating endoscope was used to perform marking, incision, submucosal dissection, and hemostasis, while a thinner, transnasal endoscope operated by a second endoscopist was used to retract connective submucosal tissue to provide cutting-line visualization using V-shaped grasping forceps. En bloc resection was achieved in all eight cases, as was complete resection. The median longest lesion diameter was 19 mm (range: 12 – 25 mm), and the median procedure time was 37.5 minutes (range: 29 – 59 minutes). There were no incidents of significant bleeding or perforation. Transnasal endoscope-assisted ESD was useful for treating gastric neoplasms in the pyloric area. The procedure was relatively easy and safe, provided excellent visualization through tissue retraction, and allowed for complete en bloc resection.

References

• 1 Oda I, Gotoda T, Hamanaka H et al. Endoscopic submucosal dissection for early gastirc cancer: technical feasibility, operation time and complications from a large consecutive series.  Dig Endosc. 2005;  17 54-58
• 2 Yamamoto H, Kawata H, Sunada K et al. Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate.  Gastrointest Endosc. 2002;  56 507-512
• 3 Oyama T, Tomori A, Hotta K et al. Endoscopic submucosal dissection of early esophageal cancer.  Clin Gastroenterol Hepatol. 2005;  3 67-70
• 4 Ohkuwa M, Hosokawa K, Boku N et al. New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife.  Endoscopy. 2001;  33 221-226
• 5 Jeon W J, You I Y, Chae H B et al. A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection.  Gastrointest Endosc. 2009;  69 29-33
• 6 Kobayashi T, Gotohda T, Tamakawa K et al. Magnetic anchor for more effective endoscopic mucosal resection.  Jpn J Clin Oncol. 2004;  34 118-123
• 7 Kondo H, Gotoda T, Ono H et al. Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer.  Gastrointest Endosc. 2004;  59 284-288
• 8 Imaeda H, Iwao Y, Ogata H et al. A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps.  Endoscopy. 2006;  38 1007-1010
• 9 Chen P J, Chu H C, Chang W K et al. Endoscopic submucosal dissection with internal traction for early gastric cancer (with video).  Gastrointest Endosc. 2008;  67 128-132
• 10 Uraoka T, Kato J, Ishikawa S et al. Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos).  Gastrointest Endosc. 2007;  66 836-839