Advertisement

Gastric Cancer

, Volume 9, Issue 1, pp 3–8 | Cite as

Endoscopic mucosal resection using a cap-fitted endoscope improves tissue resection and pathology interpretation: an animal study

  • James J. Farrell
  • Gregory Y. Lauwers
  • William R. Brugge
Original article

Abstract

Background

Endoscopic mucosal resection using a cap-fitted endoscope (EMRC) has been proposed to be significantly better and safer for tissue resection compared with standard snare EMR. However, there are no valid animal or clinical data to support this. We aimed to compare EMRC with standard snare EMR in a porcine model with respect to tissue resected, ease of procedure, and degree of diathermic injury to the resected specimen.

Methods

Gastric EMRs were randomly performed in pigs using a variety of techniques, including EMRC (1mm and 17-mm cap) and the standard snare technique, using a single-channel method without a grasping forceps. Geometric and histological assessment of the resection specimen for size, histological depth, and diathermic injury were performed by a single pathologist, blinded to the endoscopic techniques used.

Results

Thirty-six gastric mucosal resections were randomly performed in three pigs. Use of EMRC resulted in a statistically significant greater resection specimen by weight, size, and histological depth compared with standard EMR (P < 0.04). Large-cap EMRC resulted in a statistically significant greater resection weight and size compared to small-cap EMRC (P < 0.05). There was a statistically significant greater degree of diathermic injury in the specimens resected using the standard snare EMR technique compared with EMRC (P < 0.006). There were no acute complications with either technique.

Conclusion

Gastric EMRC is more technically effective than and as safe and easy as standard snare EMR. Use of the cap, especially the larger cap, is associated with larger and deeper mucosal resection and less diathermic injury compared with the standard snare technique, making the pathologic assessment of depth and margin involvement more reliable. When possible, EMRC should be the EMR method of choice.

Key words

EMR Mucosal resection Endotherapy Early esophageal cancer Early gastric cancer Cap Snare 

References

  1. 1.
    Makuuchi, H, Kise, Y, Shimada, H, Chino, O, Tanaka, H 1999Endoscopic mucosal resection for early gastric cancerSemin Surg Oncol1710816CrossRefPubMedGoogle Scholar
  2. 2.
    Ono, H, Kondo, H, Gotoda, T, Shirao, K, Yamaguchi, H, Saito, D,  et al. 2001Endoscopic mucosal resection for treatment of early gastric cancerGut482259CrossRefPubMedGoogle Scholar
  3. 3.
    Inoue, H 2001Treatment of esophageal and gastric tumorsEndoscopy3311925PubMedGoogle Scholar
  4. 4.
    Soetikno, R, Inoue, H, Chang, K 2000Endoscopic mucosal resectionGastrointest Endosc Clin N Am10595617PubMedGoogle Scholar
  5. 5.
    Deyhle, P, Largiader, F, Jenny, S 1973A method for endoscopic electroresection of sessile colonic polypsEndoscopy53840Google Scholar
  6. 6.
    Takemoto, T, Yania, H, Karita, M, Okita, K 1989Significance of strip biopsy with particular reference to endoscopic mucosectomyDig Endosc149Google Scholar
  7. 7.
    Tada, M, Murakami, A, Karita, M, Yanai, H, Okita, K 1993Endoscopic resection of early gastric cancerEndoscopy2544550PubMedGoogle Scholar
  8. 8.
    Hirao, M, Masuda, K, Asanuma, T, Naka, H, Noda, K, Matsuura, K,  et al. 1988Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrineGastrointest Endosc342649PubMedGoogle Scholar
  9. 9.
    Inoue, H, Takeshita, K, Hori, H, Muraoka, Y, Yoneshima, H, Endo, M 1993Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesionsGastrointest Endosc395862PubMedGoogle Scholar
  10. 10.
    Takeshita, K, Tani, M, Inoue, H, Saeki, I, Honda, T, Kando, F,  et al. 1997A new method of endoscopic mucosal resection of neoplastic lesions in the stomach: its technical features and resultsHepatogastroenterology44160211PubMedGoogle Scholar
  11. 11.
    Inoue, H, Kawano, T, Tani, M, Takeshita, K, Iwai, T 1999Endoscopic mucosal resection using a cap: techniques for use and preventing perforationCan J Gastroenterol1347780PubMedGoogle Scholar
  12. 12.
    Inoue, H 1998Endoscopic mucosal resection for esophageal and gastric mucosal cancersCan J Gastroenterol123559PubMedGoogle Scholar
  13. 13.
    Chonan, A, Mochizuki, F, Ando, M 1998Endoscopic mucosal resection (EMR) of early gastric cancer: usefulness of aspiration EMR using a cap-fitted scopeDig Endosc10316Google Scholar
  14. 14.
    Yamaguchi, Y, Takahashi, S 1998Endoscopic mucosal resection (EMR) of early gastric cancer: usefulness of aspiration EMR using a cap-fitted scopeGastrointest Endosc485489PubMedGoogle Scholar
  15. 15.
    Kojima, T, Parra-Blanco, A, Takahashi, H, Fujita, R 1998Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literatureGastrointest Endosc485504discussion 554–5PubMedGoogle Scholar
  16. 16.
    Low, AH, Lee, JG, Leung, JW 1999Endoscopic mucosal resection with a cap-fitted endoscope versus freehand gastric mucosectomy in an animal modelGastrointest Endosc5060812PubMedGoogle Scholar
  17. 17.
    Torii, A, Sakai, M, Kajiyama, T, Kishimoto, H, Kin, G, Inoue, K,  et al. 1995Endoscopic aspiration mucosectomy as curative endoscopic surgery; analysis of 24 cases of early gastric cancerGastrointest Endosc424759CrossRefPubMedGoogle Scholar
  18. 18.
    Tanabe, S, Koizumi, W, Kokutou, M, Imaizumi, H, Ishii, K, Kida, M,  et al. 1999Usefulness of endoscopic aspiration mucosectomy as compared with strip biopsy for the treatment of gastric mucosal cancerGastrointest Endosc5081922CrossRefPubMedGoogle Scholar
  19. 19.
    Gotoda, R, Sasako, M, Ono, H, Katai, H, Sano, T, Shimoda, T 2001Evaluation of the necessity for gastrectomy with lymph node dissection for patients with submucosal invasive gastric cancerBr J Surg884449CrossRefPubMedGoogle Scholar
  20. 20.
    Tucker, R 1999Principles of electrocauterySivak, M eds. Gastrointestinal endoscopyW.B. SaundersPhiladelphiaGoogle Scholar

Copyright information

© International and Japanese Gastric Cancer Association 2006

Authors and Affiliations

  • James J. Farrell
    • 1
  • Gregory Y. Lauwers
    • 2
  • William R. Brugge
    • 3
  1. 1.Divison of Digestive DiseasesUCLA School of MedicineLos AngelesUSA
  2. 2.Department of Pathology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Gastrointestinal Unit, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations