| Theme |
Forefront of endoscopic treatment in early colorectal cancer |
| Title |
En-bloc resection of colorectal neoplasms by endoscopic submucosal dissection, using Flex knife |
| Author |
Naohisa Yahagi |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| Author |
Mitsuhiro Fujishiro |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| Author |
Atsushi Imagawa |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| Author |
Naomi Kakushima |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| Author |
Akimitsu Okawa |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| Author |
Katsuya Kobayashi |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| Author |
Takuhei Hashimoto |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| Author |
Masashi Oka |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| Author |
Masao Omata |
Department of Gastroenterology, Faculty of Medicine, University of Tokyo |
| [ Summary ] |
Among non-granular type laterally spreading tumors (LST-NG) or depressed lesions such as 0-IIc lesions, there are quite a number of cases that involve submucosal invasion. With these types of tumors, since accurate evaluation of tumor depth and vessel infiltration is essential, en-bloc resection of the lesion is mandatory. However, the submucosal dissection method has been considered too difficult to apply to treatment of colorectal lesions, since the risk of peritonitis is so high in cases with perforations, and also because of technically difficulties, due to its narrow lumen and angulation. However, if the scope is put in an appropriate position, and the lesion is elevated enough with submucosal injection, using a solution of sodium hyaluronate, en-bloc resection is feasible. Our newly devised Flex knife, which is soft and flexible, enables us to cut in any direction. With various improvements in premedication, endoscopy systems and treatment equipment, we have safely performed en-bloc resection of colorectal lesions, even in a large tumor as large as 10cm in diameter. |