Abstract
To improve the efficacy of endosccpic mucesal resection(EMR), we invented endoscopic marginal mucosa sequential resection(EMSR), in which the surrounding mucosa of a lesion is completely cut around using EMRC. Subjects comprised 122 patients who underwent EMR at our department from October a 1990 to February 2000 (early gastric cancer: 112; recessed adenoma:10). The subjects were classified into 3 groups by resection method, i. e., early (strip biopsy), mediate (EMRC)and late groups; their results were evaluated. In the late group, total resection was performed insofar as possible; EMSR was also used if there was a possibility that the rest of a lesion might not be fully removed. The complete resection rates for single surgery were 90% and 97.6%in the mediate and late groups, respectively, a remark-able improvement in comparison with the 68.3% for the early group. Total complete resection rate in the date group was 65.9%, a remarkable improvement in comparison with the 46.3% and 47.5% for the early and mediate groups. EMSR was used in 21 patents, in all of whom complete resection was achieved in a single operation, regardless of the lesion site. The aim of EMSR Method 1, the original method, was complete resection and strict reconstruction, whereas EMSR Method 2 was applied to patients in whom resection presented difficulties. As regards complications, intraoperative hemorrhage occurred in 4 patients (19%), but was easily resolved by clipping.
