Hashimoto Kosei, Ino Yuji, Ishii Hiroaki, Shinozaki Satoshi, Miura Yoshimasa, Despott Edward J, Yano Tomonori, Yamamoto Hironori
Department of Medicine Division of Gastroenterology Jichi Medical University Tochigi Japan.
Shinozaki Medical Clinic Tochigi Japan.
DEN Open. 2024 Aug 29;5(1):e70004. doi: 10.1002/deo2.70004. eCollection 2025 Apr.
Gastric endoscopic mucosal resection is challenging due to the slippery mucosa, abundant blood vessels, and the presence of mucus. We developed gel immersion endoscopy to secure the visual field, even in a blood-filled gastrointestinal lumen in 2016. Clear gel with appropriate viscosity, instead of water, can prevent rapid mixture with blood and facilitate identification of the culprit vessel. We further optimized the gel for endoscopic treatment, and the resultant product, Viscoclear (Otsuka Pharmaceutical Factory) was first released in Japan in 2020. The viscosity of this gel has been optimized to maximize endoscopic visibility without compromising the ease of its irrigation. The aim of this study is to clarify the effectiveness of gel immersion endoscopic mucosal resection for small-sized early gastric neoplasms. Seven lesions in seven patients were treated by gel immersion endoscopic mucosal resection. The size of all lesions was under 10 mm. The median procedure time was 4.5 min. Intraoperative bleeding occurred in four of seven lesions immediately after snare resection and was easily controlled by endoscopic hemostatic forceps during the gel immersion endoscopy. The R0 resection rate was 100%. In conclusion, gel immersion endoscopic mucosal resection may be a straightforward, rapid, and safe technique for resecting superficial gastric neoplasms <10 mm in diameter.
由于胃黏膜光滑、血管丰富且存在黏液，胃内镜黏膜切除术具有挑战性。2016年，我们开发了凝胶浸没式内镜检查法，即使在充满血液的胃肠道管腔中也能确保视野清晰。用具有适当粘度的透明凝胶代替水，可以防止其与血液快速混合，并有助于识别出血血管。我们进一步优化了用于内镜治疗的凝胶，最终产品Viscoclear（大冢制药厂）于2020年在日本首次推出。这种凝胶的粘度经过优化，可在不影响冲洗便利性的情况下最大限度地提高内镜视野清晰度。本研究的目的是阐明凝胶浸没式内镜黏膜切除术治疗小尺寸早期胃肿瘤的有效性。对7例患者的7个病变进行了凝胶浸没式内镜黏膜切除术治疗。所有病变的大小均在10毫米以下。中位手术时间为4.5分钟。7个病变中有4个在圈套器切除后立即出现术中出血，在凝胶浸没式内镜检查过程中很容易通过内镜止血钳控制。R0切除率为100%。总之，凝胶浸没式内镜黏膜切除术可能是一种直接、快速且安全的技术，用于切除直径<10毫米的浅表性胃肿瘤。
