Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Endoscopy. 2011 Mar;43(3):233-5. doi: 10.1055/s-0030-1256037. Epub 2010 Dec 16.
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.
内镜黏膜下剥离术（ESD）是治疗胃腺瘤和早期胃癌（EGC）的重要治疗选择。然而，当病变位于幽门区时，ESD 技术难度较大。我们的目的是介绍经鼻内镜辅助 ESD 方法，该方法通过控制黏膜下牵引提供出色的切割线可视化效果。共有 8 例位于幽门区的胃腺瘤或 EGC 患者连续入组。主要操作内镜用于进行标记、切开、黏膜下剥离和止血，而由第二位内镜医生操作的更细的经鼻内镜则用于牵拉连接的黏膜下组织，使用 V 形抓钳提供切割线可视化效果。所有 8 例均实现整块切除和完全切除。最长病变直径的中位数为 19 毫米（范围：12-25 毫米），手术时间的中位数为 37.5 分钟（范围：29-59 分钟）。无明显出血或穿孔事件发生。经鼻内镜辅助 ESD 对于治疗幽门区的胃肿瘤是有用的。该手术相对简单、安全，通过组织牵拉提供出色的可视化效果，并允许进行完全的整块切除。
