1983 Volume 25 Issue 12 Pages 1942-1953
We have developed a new method of endoscopic resection of early gastric carcinomas and other gastric lesions with malignant potential. Characteristics of the new method are summarized as follows. 1. In order to prevent bleeding after endoscopic resection of the gastric lesion, local injection of hypertonic saline epinephrine (HS-E) solution containing 3.7% sodium chloride and 0.005% epinephrine was applied to the lesion. Even a depressed lesion like IIc type early gastric carcinoma was artificially protruded by local injection of HS-E solution. 2. Instead of single f iberscope, double fiberscopes were employed simultaneously for endoscopic resection of the lesion. 3. Prior to resection of the lesion by high frequency current snare method, incision of the mucosa along the marking line around the lesion was performed, enabling the extension of the area to be resected precisely. 4. Because tissue damage is mild, resected materials with drawn are suitable for adequate pathological study. Endoscopic resection was performed for a total of 30 gastric lesions in 29 patients. Thirty lesions consisted of early gastric carcinoma (25), ATP (4) and gastric ulcer scar (1). The size range of the resected lesions was 4-25 mm (mean 13.4 mm). The time required for endoscopic resection per lesion by this method was 15-120 min (mean 51 min). Twenty-five early gastric carcinomas resected consisted of IIc (16), IIa(6), IIa+IIc (2) and I (1). Invasion of carcinoma to the submucosa or to the resected margin was demonstrated in 10 patients. Five of them underwent gastrectomy and the rest are now under follow-up observation. Despite of repeated biopsies, no evidence of residual carcinoma or recurrence has been obtained from the follow-up group. Endoscopic resection associated perforation was complicated in two cases. In no case was observed bleeding from the resected site. Endoscopic resection by our method seems to be profitable for the treatment of early gastric carcinomas in patients at high surgical risk. It should be emphasized that endo-scopic resection by this method can be applied to depressed lesions like IIc as well as protruded ones.
