Hayashi Hiroki, Ino Yuji, Iwashita Chihiro, Sakaguchi Mio, Miura Yoshimasa, Despott Edward J, Yano Tomonori, Yamamoto Hironori
Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan.
Department of Gastroenterology and Hepatology, Mie University, Mie, Japan.
VideoGIE. 2025 Apr 9;10(9):469-474. doi: 10.1016/j.vgie.2025.03.040. eCollection 2025 Sep.
EMR and endoscopic submucosal dissection are widely used for treating intramucosal gastric neoplasms. However, securing a clear visual field in a stomach with residue is challenging. In this article, we present 2 cases in which tumors were endoscopically resected by securing the visual field using the gel immersion method in remnant stomachs after proximal gastrectomy with residue.
The gel immersion method is a technique in which a transparent, viscous gel is injected into the lumen to secure the visual field. The viscous gel displaces blood and residue, allowing for a clear view. Therefore, we could perform efficient endoscopic procedures calmly. We also used the dedicated valve to add the gel while we inserted devices through its accessory channel.
In both cases, the gel immersion method successfully displaced food residue, providing a clear visual field and enabling precise mucosal incision and resection. In the first case, we achieved en bloc resection in a 71-year-old man with a 5-mm adenoma by using gel immersion EMR. In the second case, a 74-year-old man with a 12-mm intramucosal adenocarcinoma underwent gel immersion endoscopic submucosal dissection, which facilitated an accurate incision line and effective coagulation. Both patients had negative resection margins, and no adverse events were observed.
The gel immersion method effectively improved visualization in a stomach with residue, enhancing the safety and precision of endoscopic resection.
内镜黏膜切除术（EMR）和内镜黏膜下剥离术被广泛用于治疗胃黏膜内肿瘤。然而，在有残留物的胃中确保清晰的视野具有挑战性。在本文中，我们介绍了2例近端胃切除术后残胃中有残留物的病例，通过凝胶注入法确保视野，在内镜下切除肿瘤。
凝胶注入法是一种将透明、粘性凝胶注入管腔以确保视野的技术。粘性凝胶可排出血液和残留物，从而获得清晰的视野。因此，我们能够从容地进行高效的内镜操作。我们还使用了专用阀门，在通过其辅助通道插入器械时添加凝胶。
在这两个病例中，凝胶注入法均成功排出食物残渣，提供了清晰的视野，使精确的黏膜切开和切除成为可能。在第一个病例中，我们通过凝胶注入EMR对一名患有5毫米腺瘤的71岁男性实现了整块切除。在第二个病例中，一名患有12毫米黏膜内腺癌的74岁男性接受了凝胶注入内镜黏膜下剥离术，这有助于确定准确的切口线并有效止血。两名患者的切缘均为阴性，未观察到不良事件。
凝胶注入法有效地改善了有残留物胃的视野，提高了内镜切除的安全性和精确性。
