TIPS FOR ENDOSCOPIC SUBMUCOSAL DISSECTION OF GASTRIC CANCERS THAT ARE DIFFICULT TO APPROACH BY CONVENTIONAL ENDOSCOPY

Abstract

To perform effective and safe endoscopic submucosal dissection (ESD) of large gastric neoplasms, an appropriate endoscopic view is essential; however, there are some locations in which it is difficult for the tip of the endoscope to reach the target. Some tumors are located at sites where it is difficult to get the tip of the endoscope close to the tumor, such as the lesser curvature of the gastric body and the angulus. To facilitate ESD treatment in these locations that are difficult to reach, it is important to change the patient’s position or control the volume of air in the stomach. In cases in which it is difficult to obtain an appropriate endoscopic view with these methods, a multiple-bending endoscope or a one-sided, expandable balloon (Air assist) that can be attached to a conventional endoscope makes it possible to reach sites reliably that are difficult to approach with conventional endoscopes.