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DOI: 10.1055/a-2333-9313
Gastric endoscopic submucosal dissection through a gastrostomy using a newly developed thin endoscope
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A 76-year-old man underwent follow-up endoscopy after undergoing curative endoscopic submucosal dissection (ESD) for esophageal cancer [1]. He had a past history of advanced pharyngeal cancer, which had been treated with chemoradiotherapy, and had a percutaneous endoscopic gastrostomy because of persistent trismus ([Fig. 1]). The follow-up endoscopy, performed via transnasal endoscopy, revealed a 6-mm depressed lesion in the lesser curvature of the antrum, and a biopsy confirmed adenocarcinoma ([Fig. 2]). ESD using a newly developed endoscope [2] [3] was performed to treat the gastric cancer.
First, the catheter through the gastrostomy was removed and an endoscope with a diameter of 7.9 mm (EG-840TP; Fujifilm, Tokyo, Japan) was inserted through the gastrostomy ([Fig. 3]; [Video 1]). Circumferential marking, mucosal incision, and circumferential incision were performed, and submucosal dissection was subsequently performed until the tumor was resected en bloc ([Fig. 4]), taking 9 minutes. The lesion was retrieved through the gastrostomy, and a new catheter was placed into the gastrostomy using a guidewire. The final pathologic diagnosis was a 6×6-mm, 0–IIc, well-differentiated tubular adenocarcinoma, pT1a, pUL0, ly0, v0, pHM0, pVM0.
Gastric endoscopic submucosal dissection is performed through a gastrostomy using a newly developed thin endoscope.Video 1
Although the newly developed endoscope has a large working channel of 3.2 mm and offers wide angles (up 210°; down 160°), its small width of 7.9 mm enabled efficient ESD to be performed through the gastrostomy without dilation [1].
Endoscopy_UCTN_Code_TTT_1AO_2AG_3AD
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Publikationsverlauf
Artikel online veröffentlicht:
12. Juni 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Shichijo S, Kawakami Y, Higashino K. et al. Retrograde esophageal endoscopic submucosal dissection through a gastrostomy. Endoscopy 2023; 55: E507-E508
- 2 Shichijo S, Miyake M, Ishihara R. Usefulness of the ultrathin endoscope with a newly developed knife for complex esophageal endoscopic submucosal dissection. VideoGIE 2023; 8: 183-185
- 3 Shichijo S, Kawakami Y, Kizawa A. et al. Endoscopic submucosal dissection for a duodenal polyp at the upper aspect of the duodenal bulb using a newly developed endoscope. VideoGIE 2023; 8: 509-511