Submucosal injection of ethanol under direct vision for the treatment of gastric protuberant lesion

Abstract

For the experiment of artificial ulcer formation in stomach, dogs were used under anesthesis of Ketamine and various agents were injected to the dog's stomach via gastrofiberscope. Healing state of the artificial ulcer was followed-up endoscopically, then sacrificed to check the depth of ulcer. To summerize the characteristics of the artificial ulcer caused by submucosal injection of 95% ethanol, 1) immediate change in the mucosa, 2) easy to control the depth and size, 3) rapid repair, 4) easy and safely to handle for popular material. By using this technique of ulcer formation, obliteration of gastric protuberant lesion was attempted clinically. Obliteration of the lesion was comfirmed by gastrofiberscopy intruding biopsy and aspiration cytology. In some cases, histological examination of the resected stomach was done after operation. Treatment by submucosal injection of 95% ethanol was successfully performed in 51 of 54 cases. Successful cases were intruded not only hyperplastic polyps but also 16 cases of atypical epithelial hyperplasia and 2 cases of early gastric cancer type II a. Complete healing was seen within 6 weeks in every cases and no massive bleeding nor perforation was experienced. Since the technique of thermoelectrical polypectomy was introduced to gastrof iberscopy, excision biopsy is most desirable in narrow-based and pedunculated polyps, however for wide-based polypoid growths, the satisfactory results have not been reported yet. Our trials of polypectomy by using this technique is a kind of steps for management of a small early gastric cancer in poor risk patients. Recent follow-up study revealed the low incidence of malignant change from gastric polyp or atypical epithelial hyperplasia. However follow-up term is not long enough to deny their malignant changes, today. Long term follow-up examination like more than 10 years is not easy for both patients and doctors. Therefore in a patient who is difficult to followed-up for other complications and/or who feels uneasy about the gastric polypoid growth, treatment by submucosal injection of 95% ethanol is recommended. Additionally in a case, of elevated type of early gastric cancer less than 2 cm in diameters, of which depth involvement is confined within mucosal level, it is reasonable to obliterate the cancer nests by making Ul-II ulcer, if the patient is in poor risk for surgical operation.