2020 Volume 62 Issue 1 Pages 53-58
An 83-year-old man was scheduled to undergo upper gastrointestinal endoscopy. Past medical history revealed that the patient had been diagnosed with situs inversus totalis by x-ray examination 16 years previously. Upper gastrointestinal endoscopy was initially performed with the patient lying on his left side. Insufflation failed to inflate the gastric antrum sufficiently to allow observation, and air continued to flow toward the gastric body. As a result, the patient suffered from gastric mucosal laceration. Upper gastrointestinal endoscopy was therefore performed again with the patient lying on his right side. The gastric antrum was inflated sufficiently for observation. During this endoscopic examination and the subsequent endoscopic examination, the patient was found to have a total of three gastric lesions: a 0-Ⅱc lesion at the anterior wall, 20 mm in diameter; a 0-Ⅱc lesion at the greater curvature, 15 mm in diameter; and a 0-Ⅱa lesion at the greater curvature, 10 mm in diameter. Pathologic examination showed that the patient had triple early gastric cancer.
We performed endoscopic submucosal dissection with the patient lying on his right side, while the operator and endoscopic unit were positioned on the side opposite the side on which they would normally be positioned when the usual operation is being performed with the patient lying on his left side.
This setup enabled us to adequately perform endoscopic submucosal dissection, and curative resection of all three lesions was achieved endoscopically.
