NEAR-SIDE APPROACH METHOD BY USING IT KNIFE IN GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract

Gastric endoscopic submucosal dissection (ESD) has been performed over a longer period of time than ESD for lesions located in other regions of the gastrointestinal tract, and gastric ESD has become the standard treatment for early gastric cancer. However, only experienced endoscopists can complete gastric ESD for technically difficult lesions located in the greater curvature of the gastric body and fornix of the stomach. Furthermore, gastric ESD is associated with bleeding; therefore, it is very important to learn how to successfully control bleeding during ESD. When gastric ESD is performed for lesions located in the gastric body, we apply the near-side approach method that combines the strategy of ESD using a needle-type knife and the strategy of ESD using an IT knife. The traction method using the clip-with-line technique is known to be very effective for shortening the procedure time of gastric ESD, particularly for lesions in the greater curvature. These strategies and tips lead to the success of gastric ESD even for technically difficult lesions.