Imaeda H, Iwao Y, Ogata H, Ichikawa H, Mori M, Hosoe N, Masaoka T, Nakashita M, Suzuki H, Inoue N, Aiura K, Nagata H, Kumai K, Hibi T
Center for Diagnostic and Therapeutic Endoscopy, Keio University Hospital, Tokyo, Japan.
Endoscopy. 2006 Oct;38(10):1007-10. doi: 10.1055/s-2006-925264. Epub 2006 Apr 27.
Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has improved the success rate of en-bloc resection. We report here on a new technique using an external grasping forceps.
A total of 25 patients with suitable EGCs over 10 mm in diameter located in the gastric body were enrolled. After submucosal injection followed by circumcision of the lesion with a needle-knife, an external grasping forceps was introduced with the help of a second grasping forceps and anchored at the distal margin of the lesion. With gentle oral traction applied with this forceps, the lesion was dissected endoscopically in retroversion from the aboral side.
The mean lesion size was 15.0 mm (range 10 - 25 mm). Using the technique described, all lesions could be resected en bloc with free margins. The mean procedure time was 45 min (range 30 - 80 minutes). No significant bleeding requiring blood transfusion or perforation occurred.
This technical modification may simplify and shorten the gastric ESD procedure, except for lesions in distal locations, without compromising the efficacy.
早期胃癌的内镜黏膜下剥离术（ESD）提高了整块切除的成功率。我们在此报告一种使用外部抓钳的新技术。
共纳入25例胃体部直径超过10 mm的合适早期胃癌患者。黏膜下注射后，用针刀环切病变，借助另一把抓钳引入外部抓钳并固定在病变远端边缘。通过该抓钳轻柔地向口腔方向牵引，在内镜下从背侧以反转方式剥离病变。
病变平均大小为15.0 mm（范围10 - 25 mm）。使用所述技术，所有病变均能整块切除且切缘阴性。平均手术时间为45分钟（范围30 - 80分钟）。未发生需要输血的明显出血或穿孔。
这种技术改进可能会简化和缩短胃ESD手术，除了病变位于远端的情况，且不影响疗效。
