Piecemeal Endoscopic Aspiration Mucosectomy for Large Superficial Intramucosal Tumors of the Stomach

Background and Study Aims: As endoscopic techniques continue to develop, endoscopic mucosal resection is increasingly being used in the treatment of intramucosal gastric tumors. The aim of this study was to explore the feasibility of piecemeal endoscopic aspiration mucosectomy for large superficial intramucosal tumors of the stomach. Patients and Methods: The study group consisted of five consecutive patients with large superficial intramucosal tumors of the stomach, 4 cm or more in diameter. Piecemeal endoscopic aspiration mucosectomy using a capfitted panendoscope was carried out. The initial resection was undertaken at the oral side of the lesion. Subsequent resections were carried out along the anal margin of the previous resection site, until the marks around the boundary of the tumor completely disappeared. Results: The shape of the tumors was slightly elevated in four cases and slightly depressed in one. The mean diameter of the tumors was 4.8 cm. The diameters of the resected specimens ranged from approximately 1.0 cm to 2.3 cm. The numbers of piecemeal resection procedures needed per lesion ranged from five to 18 (mean 11). The visual field was well ensured by the cap, and the tumors were macroscopically completely resected without any complications in all patients. The final histological diagnoses in the specimens were adenoma in one case and mucosal carcinoma in adenoma in four. One patient had residual or recurrent tumor, and received full treatment with additional endoscopic procedures. Conclusions: Piecemeal endoscopic aspiration mucosectomy is a simple and very useful technique for treating large superficial intramucosal tumors of the stomach.