Double-endoscope endoscopic submucosal dissection for the treatment of early gastric cancer accompanied by an ulcer scar (with video)

• Published in: Gastrointestinal endoscopy 2013-08, Vol.78 (2), p.266-273
• Main Authors: Higuchi, Katsuhiko, MD, PhD, Tanabe, Satoshi, MD, PhD, Azuma, Mizutomo, MD, PhD, Sasaki, Tohru, MD, PhD, Katada, Chikatoshi, MD, PhD, Ishido, Kenji, MD, PhD, Naruke, Akira, MD, Mikami, Tetuo, MD, PhD, Koizumi, Wasaburo, MD, PhD
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Cicatrix - complications; Dissection - methods; Female; Gastric Mucosa - surgery; Gastroenterology and Hepatology; Gastroscopes; Gastroscopy - methods; Humans; Male; Middle Aged; Operative Time; Retrospective Studies; Stomach Neoplasms - complications; Stomach Neoplasms - surgery; Stomach Ulcer - complications; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2013.01.010

Background Endoscopic submucosal dissection (ESD) for early gastric cancer accompanied by an ulcer scar remains challenging. Several counter-traction techniques have been attempted to facilitate ESD, but a standard procedure remains to be established. Objective To evaluate the efficacy and safety of double-endoscope ESD by using a single light source in patients with early gastric cancer accompanied by an ulcer scar. Design Single center, retrospective study. Setting Kitasato University East Hospital. Patients A total of 30 early gastric cancers with ulcer scars were treated by double-endoscope ESD in 30 patients from October 2008 through May 2012. Intervention Double-endoscope ESD. Main Outcome Measurements En bloc resection rate, complete resection rate, treatment time, and adverse events. Results The use of two endoscopes for ESD provided a good field of vision and allowed counter-traction to be applied to the lesion, clearly facilitating submucosal dissection. Because only a single light source was used, the working space of the endoscope room was not compromised. Moreover, it was unnecessary to prepare another light source or to coordinate image filing. The en bloc resection rate and complete resection rate were 100% and 90%, respectively, and the median treatment time was 80 minutes. As compared with historical control data obtained before the introduction of double-endoscope ESD, the rate of cutting into the specimen was significantly lower (7% vs 35%; P = .01). No serious adverse events occurred during the procedure. Postoperatively, however, 3 patients (10%) had delayed hemorrhage, and 1 (3.3%) had a delayed perforation. Limitations Single-center, nonrandomized study. Conclusion Our experience indicates that our procedure for double-endoscope ESD is useful and feasible in patients with early gastric cancer accompanied by an ulcer scar.