Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T, Sekine Y, Yano T, Satoh K, Ido K, Sugano K
Dept. of Gastroenterology, Jichi Medical School, Tochigi, Japan.
Endoscopy. 2003 Aug;35(8):690-4. doi: 10.1055/s-2003-41516.
En-bloc resection is desirable for accurate histopathological assessment of tissue specimens obtained using endoscopic mucosal resection (EMR). A new EMR method using sodium hyaluronate and a small-caliber-tip transparent hood has been developed. This is a peeling-off method using a needle-knife for mucosal and submucosal incisions. Long-lasting submucosal thickening resulting from an injection of sodium hyaluronate, and good visualization of the submucosal tissue with the aid of a small-caliber-tip transparent hood, make the cutting procedures easy and safe. A large superficial gastric cancer and a large villous tumor of the sigmoid colon were endoscopically resected using this method. En-bloc endoscopic resection was successful in both patients. The gastric lesion was an well-differentiated intramucosal adenocarcinoma, completely resected in a specimen measuring 97 x 50 mm. The colonic lesion was an intramucosal well-differentiated adenocarcinoma in adenoma, completely resected in a specimen measuring 70 x 55 mm in diameter. No significant complications were noted in either patient. The new method of EMR using sodium hyaluronate and the small-caliber-tip transparent hood is a promising method for endoscopic en-bloc resection of large superficial neoplastic lesions, both in the stomach and the colon.
整块切除对于使用内镜黏膜切除术（EMR）获取的组织标本进行准确的组织病理学评估是可取的。一种使用透明质酸钠和小口径尖端透明帽的新型EMR方法已经研发出来。这是一种使用针刀进行黏膜和黏膜下切口的剥离方法。透明质酸钠注射导致持久的黏膜下增厚，并且借助小口径尖端透明帽能很好地观察黏膜下组织，使得切割操作简单且安全。使用该方法对一例大的浅表性胃癌和一例乙状结肠大的绒毛状肿瘤进行了内镜下切除。两名患者均成功实现整块内镜切除。胃部病变为高分化黏膜内腺癌，在一个尺寸为97×50毫米的标本中完全切除。结肠病变为腺瘤内的黏膜内高分化腺癌，在一个直径为70×55毫米的标本中完全切除。两名患者均未出现明显并发症。使用透明质酸钠和小口径尖端透明帽的新型EMR方法对于胃和结肠的大型浅表性肿瘤性病变的内镜整块切除是一种有前景的方法。
