Gastric endoscopic submucosal dissection using sodium carboxymethylcellulose as a new injection substance

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  • Hikichi Takuto
    Department of Endoscopy, Fukushima Medical University Hospital
  • Yamasaki Masahiro
    Third Department of Internal Medicine, University of Occupational and Environmental Health Division of Gastroenterology, Fukushima Rosai Hospital
  • Watanabe Ko
    Department of Endoscopy, Fukushima Medical University Hospital Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Nakamura Jun
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Sato Masaki
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Takagi Tadayuki
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Suzuki Rei
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Sugimoto Mitsuru
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Kikuchi Hitomi
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Konno Naoki
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Waragai Yuichi
    Department of Endoscopy, Fukushima Medical University Hospital Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Asama Hiroyuki
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Takasumi Mika
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Ejiri Yutaka
    Division of Gastroenterology, Fukushima Rosai Hospital
  • Watanabe Hiroshi
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Ohira Hiromasa
    Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
  • Obara Katsutoshi
    Department of Advanced Gastroenterological Endoscopy, Fukushima Medical University

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AIM: To investigate the feasibility of endoscopic submucosal dissection (ESD) using sodium carboxymethylcellulose (SCMC) for gastric cancer.<br>METHODS:During October 2011 through April 2013, 98 lesions from 98 patients who underwent ESD using SCMC (ESD-SCMC) for early gastric cancer were enrolled in this study.　Two endoscopists, who had each performed fewer than 30 ESD procedures (less-experienced ESD physicians), performed ESD-SCMC under the supervision of two experts.　The primary outcome was the en bloc resection rate.　Secondary outcomes included the complete resection rate, the procedural time, the bleeding rate after SCMC injection, and complications.　Patient characteristics, time necessary for hemostasis after SCMC injection, rate of treatment completion by less-experienced ESD physicians alone, and the effects of SCMC during ESD and on resected specimens were also evaluated.<br>RESULTS:The en bloc resection rate was 100%.　Among these resections, 87.8% of the cases were completed by a less-experienced ESD physician alone.　The complete resection rate was 98.0%.　The mean total procedural time was 75.4 min.　The mean incidence of intraoperative bleeding following SCMC local injection was 1.7 times.　No bleeding was observed after SCMC injection in 29.6% of cases (29/98).　Five complications occurred: one case of microperforation (1.0%) and four cases of postoperative bleeding (4.0%).　SCMC remained in the submucosa.　The submucosa was readily manipulated when the deep submucosa was dissected, even after placing the specimen on a slide.<br>CONCLUSION:ESD-SCMC is feasible for the resection of early gastric cancer.

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