Background and study aims: Endoscopic submucosal dissection (ESD) using insulation-tipped knives (IT knives)
to treat gastric lesions located on the greater curvature of the gastric body remains
technically challenging because of the associated bleeding, control of which can be
difficult and time consuming. To eliminate these difficulties, we developed a novel
strategy which we have called the “near-side approach method” and assessed its utility.
Patients and methods: We reviewed patients who underwent ESD for solitary early gastric cancer located
on the greater curvature of the gastric body from January 2003 to September 2014.
The technical results of ESD were compared between the group treated with the novel
near-side approach method and the group treated with the conventional method.
Results: This study included 238 patients with 238 lesions, 118 of which were removed using
the near-side approach method and 120 of which were removed using the conventional
method. The median procedure time was 92 minutes for the near-side approach method
and 120 minutes for the conventional method. The procedure time was significantly
shorter in the near-side approach method arm. Although, the procedure time required
by an experienced endoscopist was not significantly different between the two groups
(100 vs. 110 minutes), the near-side approach group showed significantly shorter procedure
time for a less-experienced endoscopist (90 vs. 120 minutes).
Conclusions: The near-side approach method appears to require less time to complete gastric ESD
than the conventional method using IT knives for technically challenging lesions located
on the greater curvature of the gastric body, especially if the procedure is performed
by less-experienced endoscopists.
