Endoscopic submucosal dissection for early gastric cancer, using a disposable endoscope

The environment in reusable endoscopes is conducive to bacterial growth [1] [2] because of difficult-to-clean areas, deterioration with reprocessing, and surface abrasion. Hence, the risk of cross-infection has been reported [3]. Single-use endoscopes can solve these problems. Diagnostic esophagogastroduodenoscopy using a novel sterile single-use disposable endoscope (Ambu aScope Gastro; Ambu, Ballerup, Denmark) has been reported in recent years ([Fig. 1]) [4].

Fig. 1 The Ambu aScope Gastro single-use device: diameter 9.9 mm; working channel 2.8 mm; bending angle, up 210°, down 90°, left 100°, right 100°; and equipped with two light-emitting diodes (LEDs).

Endoscopic submucosal dissection (ESD) is widely performed for early-stage gastric cancer regardless of tumor size, morphology, and location. ESD is minimally invasive and can achieve high en bloc and complete resection rates [5]. Here, we present a case of early gastric cancer resected by means of ESD using the abovementioned single-use disposable endoscope ([Video 1]).

Video 1 Endoscopic submucosal dissection (ESD) of an early gastric cancer by means of a single-use disposable endoscope.

A 70-year-old woman with early gastric cancer was referred for ESD. The tumor (5 mm, 0-IIc) was located at the anterior wall of the greater curvature of the middle body. The tumor was well-demarcated by magnified narrow band imaging (NBI) ([Fig. 2]). A DualKnife J 2.0 mm (Olympus Medical Systems, Tokyo, Japan) with magnified NBI via a GIF-XZ1200 (Olympus) was used for marking. The endoscope was changed for the single-use disposable endoscope when marking had been done, and the ESD procedure was performed using the single-use scope. Imaging and maneuverability were adequate for performing mucosal incision and submucosal dissection ([Fig. 3 a]). The clip-and-line traction method was successfully applied by means of the 2.8-mm working channel ([Fig. 3 b]). In addition, the bleeding point could be identified using the waterjet function of the device ([Video 1]). Hence, the tumor was completely resected ([Fig. 3 c]) without any major complications. The pathological finding was adenocarcinoma of fundic gland type, SM1, Ly0, V0, HM0, and VM0, with curative resection.

Fig. 2 Magnified narrow-band imaging (NBI) image of early gastric cancer (yellow arrowheads), using a GIF-XZ1200.

Fig. 3 After marking had been done, gastric endoscopic submucosal dissection (ESD) was performed employing the single-use gastroscope. a Mucosal incision. b Clip-and-line traction was successfully applied. c The tumor was completely removed.

Our case demonstrates a successful gastric ESD with a single-use disposable scope. This device could be considered as an alternative to reusable endoscopes if an appropriate case is selected.

Endoscopy_UCTN_Code_TTT_1AO_2AC

Competing interests

Ambu K. K., the manufacturer of Ambu aScope Gastro that was used in this study, provided the product sample at no cost.

• References

• 1 Decristoforo P, Kaltseis J, Fritz A. et al. High-quality endoscope reprocessing decreases endoscope contamination. Clin Microbiol Infect 2018; 24: 1101.e1-1101.e6
• 2 Saliou P, Le Bars H, Payan C. et al. Measures to improve microbial quality surveillance of gastrointestinal endoscopes. Endoscopy 2016; 48: 704-710
• 3 Ribeiro MM, de Oliveira AC. Analysis of the air/water channels of gastrointestinal endoscopies as a risk factor for the transmission of microorganisms among patients. Am J Infect Control 2012; 40: 913-916
• 4 Lagström R, Stigaard T, Knuhtsen S. et al. sDiagnostic esophagogastroduodenoscopy performed using a novel sterile single-use disposable endoscope. Endoscopy 2022; 54: E1034-E1035
• 5 Ono H, Yao K, Fujishiro M. et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc 2016; 28: 3-15

Publication History

Article published online:
13 July 2023