Published online Jul 21, 2014. doi: 10.3748/wjg.v20.i27.9210
Revised: March 2, 2014
Accepted: March 19, 2014
Published online: July 21, 2014
Endoscopic submucosal dissection is an effective treatment modality for early gastric cancer (EGC), though the submucosal fibrosis found in ulcerative EGC is an obstacle for successful treatment. This report presents two cases of ulcerative EGC in two males, 73- and 80-year-old, with severe fibrosis. As endoscopic ultrasonography suggested that the EGCs had invaded the submucosal layer, the endoscopic submucosal tunnel dissection salvage technique was utilized for complete resection of the lesions. Although surgical gastrectomy was originally scheduled, the two patients had severe coronary heart disease, and surgeries were refused because of the risks associated with their heart conditions. The endoscopic submucosal tunnel dissection salvage technique procedures described in these cases were performed under conscious sedation, and were completed within 30 min. The complete en bloc resection of EGC using endoscopic submucosal tunnel dissection salvage technique was possible with a free resection margin, and no other complications were noted during the procedure. This is the first known report concerning the use of the endoscopic submucosal tunnel dissection salvage technique salvage technique for treatment of ulcerative EGC. We demonstrate that endoscopic submucosal tunnel dissection salvage technique it is a feasible method showing several advantages over endoscopic submucosal dissection for cases of EGC with fibrosis.
Core tip: The fibrosis found in ulcerative early gastric cancer (EGC) has been an obstacle to successful endoscopic submucosal dissection (ESD). This report demonstrates the first use of the endoscopic submucosal tunnel dissection (ESTD) salvage technique for treatment of ulcerative EGC with fibrosis. ESTD involves the use of an endoscopic cap under the tunnel flap, which enables a clear view of the submucosal dissection line, making it easier than conventional ESD to resect an EGC lesion without complication. Therefore, the ESTD salvage technique has several advantages for resection of EGC with severe fibrosis due to previous ESD or severe ulceration.