Gastric Cancer

, Volume 11, Issue 1, pp 47–52

Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer

  • Hiroyuki Ono
  • Noriaki Hasuike
  • Tetsuya Inui
  • Kohei Takizawa
  • Hisatomo Ikehara
  • Yuichiro Yamaguchi
  • Yosuke Otake
  • Hiroyuki Matsubayashi
Original Article

Abstract

Background

Although endoscopic submucosal dissection (ESD) of early gastric cancer using an insulation-tipped diathermic (IT) knife enables the removal of large and ulcerative lesions en bloc, expert endoscopic skill is required. We developed an improved IT knife (IT-2) and compared its efficacy and safety with that of the original IT knife (IT-OM).

Methods

We performed ESD of 602 gastric cancers. Of these, 314 previously untreated single lesions of initial onset were analyzed. Operating time, rate of en-bloc resection, and incidence of complications were compared in the IT-2 group (161 patients) and IT-OM group (153 patients). Lesions were further analyzed as to whether they met the Japanese Gastric Cancer Association indications for ESD or extended indications.

Results

Mean resection time was significantly shorter in the IT-2 than in the IT-OM group (48 vs 63 min). There were fewer surgeries lasting longer than 2 h in the IT-2 group than in the IT-OM group (3% vs 12%). En-bloc and margin-free resection rates in the IT-OM and IT-2 groups were 95% and 99%, respectively. Perforations occurred in 3.9% of patients in the IT-OM group and in 5% of patients in the IT-2 group (difference not significant [NS]). The incidence of postoperative hemorrhage was 7.8% in the IT-OM group and 8.7% in the IT-2 group (NS). In both groups, complications were treated endoscopically, and emergency surgery was unnecessary.

Conclusion

Resectability and complication rates were similar in the two groups. However, operating time was shorter with IT-2, irrespective of the indications for the performance of ESD. This study suggests benefits of the IT-2 over the IT-OM.

Key words

IT knife 2 ESD Gastric cancer 

References

  1. 1.
    Ono H, Gotoda T, Kondo H, Yamaguchi H, Kozu T, Fujii T, et al. A new method of EMR using insulation-tipped diathermia knife (in Japanese, with English abstract). Endosc Dig 1999;11:675–681.Google Scholar
  2. 2.
    Hosokawa K, Yoshida S. Recent advances in endoscopic mucosal resection for early gastric cancer (in Japanese, with English abstract). Jpn J Cancer Chemother 1998;25:476–483.Google Scholar
  3. 3.
    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001;48:225–229.PubMedCrossRefGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association. Gastric cancer treatment guideline (in Japanese). Tokyo: Kanehara; 2004.Google Scholar
  5. 5.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, et al., Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000;3:219–225.PubMedCrossRefGoogle Scholar
  6. 6.
    Oyama T, Kikuchi Y. Aggressive endoscopic mucosal resection in the upper GI tract: hook knife EMR method. Minim Invasive Ther Allied Technol 2002;11:291–295.Google Scholar
  7. 7.
    Yahagi N, Fujishiro M, Kakushima N, Kobayashi K, Hashimoto T, Oka M, et al. Endoscopic submucosal dissection for early gastric cancer using the tip of an electro-surgical snare (thin type). Dig Endosc 2004;16:34–38.CrossRefGoogle Scholar
  8. 8.
    Yamamoto H, Sekine Y, Higasizawa T, Kihara K, Kaneko Y, Hosoya Y, et al. Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps. Gastrointest Endosc 2001;54:629–633.PubMedCrossRefGoogle Scholar
  9. 9.
    Kojima T, Parra-Blanco A, Takahashi H, Fujita R. Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc 1998;48:550–555.PubMedGoogle Scholar
  10. 10.
    Kaneko E, Hanada H, Kasugai T, Ogoshi K, Niwa K. The survey of gastrointestinal endoscopic complications in Japan (in Japanese). Gastroenterol Endosc 2000;42:308–313.Google Scholar
  11. 11.
    Minami S, Gotoda T, Ono H, Oda I, Hamanaka H. Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery. Gastrointest Endosc 2006;63:596–601.PubMedCrossRefGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2008

Authors and Affiliations

  • Hiroyuki Ono
    • 1
  • Noriaki Hasuike
    • 1
  • Tetsuya Inui
    • 1
  • Kohei Takizawa
    • 1
  • Hisatomo Ikehara
    • 1
  • Yuichiro Yamaguchi
    • 1
  • Yosuke Otake
    • 1
  • Hiroyuki Matsubayashi
    • 1
  1. 1.Division of Endoscopy and GI OncologyShizuoka Cancer Center HospitalShizuokaJapan

Personalised recommendations