Suto Daisuke, Yoshida Masashi, Otake Takaaki, Osawa Yosuke, Akita Takayuki, Sato Kiichi, Yamada Hidehiko, Odaira Hironori, Suzuki Yutaka, Kohgo Yutaka
Department of Gastroenterology, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Department of Surgery, International University of Health and Welfare Hospital, 537-3, Iguchi, Nasushiobara, Tochigi, 329-2763, Japan.
Ann Med Surg (Lond). 2022 Sep 21;82:104743. doi: 10.1016/j.amsu.2022.104743. eCollection 2022 Oct.
Gel immersion endoscopy was developed by Yano for the treatment of bleeding. In this case, we performed gel immersion endoscopic mucosal resection to treat a bleeding gastric cancer. An 80-year-old man, with chronic renal failure and on aspirin treatment for ischemic heart disease, underwent endoscopic treatment for multiple early gastric cancers on the anterior and posterior walls of the pyloric ring. An endoscopic submucosal dissection was performed for gastric cancer on the anterior wall; however, the removal of the cancer on the posterior wall was complicated by tumor prolapse and bleeding. Gel formulation (VISCOCLEAR® Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan) was used to immerse the bleeding tumor and subsequently facilitate the endoscopic mucosal resection. Various factors, such as the use of antithrombotic medication and underlying renal disease, can increase the risk of bleeding during endoscopic gastric cancer resection. If bleeding persists, the resection margin becomes obscured. Gel formulations, such as VISCOCLEAR®, can be applied to control bleeding and improve visibility. In this case, gel immersion was useful for endoscopic mucosal resection of the bleeding tumor. The use of gel immersion endoscopic resection should be considered for the treatment of early gastric cancer, however further cases should be evaluated.
凝胶浸泡式内镜由矢野开发用于治疗出血。在此病例中，我们采用凝胶浸泡式内镜黏膜切除术治疗一例出血性胃癌。一名80岁男性，患有慢性肾衰竭且因缺血性心脏病接受阿司匹林治疗，因幽门环前后壁多发早期胃癌接受内镜治疗。对前壁的胃癌进行了内镜黏膜下剥离术；然而，后壁肿瘤的切除因肿瘤脱垂和出血而变得复杂。使用凝胶制剂（日本德岛大冢制药株式会社的VISCOCLEAR®）浸泡出血肿瘤，随后便于进行内镜黏膜切除术。各种因素，如使用抗血栓药物和潜在的肾脏疾病，可增加内镜下胃癌切除术中出血的风险。如果出血持续，切除边缘会变得模糊不清。像VISCOCLEAR®这样的凝胶制剂可用于控制出血并提高视野清晰度。在此病例中，凝胶浸泡对出血肿瘤的内镜黏膜切除术很有用。对于早期胃癌的治疗应考虑使用凝胶浸泡式内镜切除术，不过还需评估更多病例。
