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DOI: 10.1055/a-2601-0106
Underwater endoscopic resection for flat lesions in the stomach often results in immediate bleeding?
Authors
Conventional endoscopic mucosal resection (EMR) often presents challenges when treating flat lesions in the stomach. In this study, we successfully performed underwater endoscopic mucosal resection (UEMR) in three cases of flat pre-cancerous lesions located in the gastric body ([Video 1]).
Underwater endoscopic mucosal resection (UEMR) in three cases of flat pre-cancerous lesions located in the gastric body.Video 1The first case involved a 71-year-old woman who underwent an outpatient magnified gastroscopy screening for monitoring a flat lesion in the gastric body. During the procedure, a 6 mm flat elevated lesion was identified on the anterior wall of the middle gastric body ([Fig. 1] a, b). Given the economic and time-efficiency advantages over endoscopic submucosal dissection (ESD), UEMR was chosen for this procedure. Despite the use of anesthesia, the patient’s respiratory movements caused significant gastric wall activity. To address this, the lesion was marked with a snare tip ([Fig. 1] c), intraluminal gas was evacuated, and the gastric lumen was immersed in normal saline ([Fig. 1] d). This strategy effectively reduced gastric activity, allowing for easier lesion grasping with the snare. The lesion was successfully resected without perforation, though significant arterial bleeding occurred ([Fig. 1] e), which was promptly managed with electrocautery ([Fig. 1] f, g).
The other two cases involved flat lesions located on the greater curvature of the gastric body, each approximately 5 mm in size. Both lesions were successfully resected using UEMR; however, immediate postoperative bleeding occurred in both cases, which was effectively controlled using electrocautery. Pathological examination confirmed adenomas with negative surgical margins in all three cases ([Fig. 1] h).
In summary, UEMR demonstrates an efficient and rapid alternative to ESD for the removal of flat gastric lesions. However, the occurrence of immediate postoperative bleeding highlights the necessity for careful monitoring and prompt intervention.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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Publication History
Article published online:
18 June 2025
© 2025. 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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