Successful en bloc resection of a large superficial gastric cancer by using sodium hyaluronate and electrocautery incision forceps

Background: The advisability of endoscopic mucosal resection (EMR) for treatment of large superficial gastric cancers has been challenged. For more reliable en bloc resection, a new method of EMR was developed that uses a viscous substance, sodium hyaluronate, and two newly designed devices. Methods: A large superficial gastric cancer was treated with this new EMR technique. Sodium hyaluronate was injected into the submucosa and mucosal incisions were made with a needle-knife. The newly developed incision forceps and flat-ended transparent hood were used for submucosal incisions. Results: The large cancer was successfully resected endoscopically as a single piece of mucosa 6 cm in diameter without complication. Histopathologic evaluation of the specimen confirmed that the resection was curative. Conclusions: EMR with sodium hyaluronate along with two new devices may be a reliable method for en bloc resection of large superficial gastric lesions.