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 15.6 mm and 32.7 mm, respectively. Curative en-bloc resection rates according to tumor size and location were 96% (26/27) in tumors ≤20 mm, 100% (8/8) in tumors >20 mm, 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 93.4 min in tumors ≤20 mm, 140 min in tumors >20 mm, 77.6 min for tumors in the lower portion, 113.4 min for tumors in the middle portion, 148.6 min for tumors in the upper portion, and 104.1 min 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.