Endoscopic submucosal dissection using a grasping-type scissors forceps for early gastric cancers and adenomas.

AIM: To reduce the risk of complications related to endoscopic submucosal dissection (ESD) using knives, we developed a new grasping-type scissors forceps (GSF) that can grasp and incise the target tissue using electrosurgical current. The aim of the present study was to evaluate the efficacy and safety of ESD using GSF for the removal of early gastric cancers and adenomas. METHODS: ESD using GSF was carried out on 35 consecutive patients with early gastric cancers or adenomas who had preoperative EUS diagnoses of mucosal tumor without lymph node involvement. Therapeutic efficacy and safety were assessed. RESULTS: All lesions were treated easily and safely without unexpected incision. The mean size of epithelial tumors and resected specimens was 15.6mm and 32.7mm, respectively. Curative en-bloc resection rates according to tumor size and location were 96% (26/27) in tumors ≤20mm, 100% (8/8) in tumors >20mm, 100% (18/18) of tumors in the lower portion, 100% (8/8) of tumors in the middle portion, 89% (8/9) of tumors in the upper portion, and 97% (34/35) overall. The mean operating time according to tumor size and location was 93.4min in tumors ≤20mm, 140min in tumors >20mm, 77.6min for tumors in the lower portion, 113.4min for tumors in the middle portion, 148.6min for tumors in the upper portion, and 104.1min overall. No intraoperative complication occurred, and postoperative bleeding was seen in 3% (1/35). CONCLUSIONS: ESD using GSF allows simple and safe en-bloc resection of early gastric cancer or adenoma irrespective of tumor size and location.

Is double-balloon colonoscopy a better aid to unskilled colonoscopists than conventional colonoscopy?

BACKGROUND AND STUDY AIMS: To compare the clinical outcome of double-balloon colonoscopy (DBC) with conventional colonoscopy (CC) for colon evaluation performed by an unskilled colonoscopist. PATIENTS AND METHODS: Between June 2008 and November 2008, 1544 colonoscopies were performed in our hospital. Fifty-eight patients, (29 male and 29 female ; 19-86 years; mean age, 63 years) involving 60 intubations, were enrolled in this study and were assigned randomly to the DBC or CC group. One first-year GI fellow was enrolled and performed these 60 consecutive colonoscopies (30 DBCs, 30 CCs). Completion rate of colonoscopy, cecal intubation time, and rate of analgesic agent usage were analyzed. RESULTS: Completion of DBC was 100% (30/30), while completion of CC was 73% (22/30). There was a statistically significant difference (p < 0.05). The mean cecal intubation time was 36.2 +/- 14.4 minutes (DBC) and 36.5 +/- 15.2 minutes (CC). There was no statistically significant difference. Analgesic agent was used with 19 intubations (63%) (DBC) and with 27 intubations (90%) (CC) (p < 0.05). CONCLUSIONS: For inexpert endoscopists, using DBC has a higher rate of effectiveness than using CC and can decrease the discomfort of patients during colonoscopic procedures.

Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps.

Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the inability to fix the knife to the target lesion, and compression of the lesion. These can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using electrosurgical current. Colonoscopy on a 55-year-old woman revealed a 10-mm rectal submucosal nodule. The histological diagnosis of the specimen obtained by biopsy was carcinoid tumor. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. It was safely and accurately resected without unexpected incision by ESD using a GSF. No delayed hemorrhage or perforation occurred. Histological examination confirmed the carcinoid tumor was completely excised with negative resection margin.