In an 82-year-old woman, two 20-mm polyps were identified at the greater curvature of the middle stomach body during esophagogastroduodenoscopy with a high-definition magnifying endoscope (GIF-H290Z, Olympus, Tokyo, Japan). Both lesions were in close contact with the stomach wall due to the influence of gravity, and their morphology could not be accurately determined (Video 1,Fig. 1a). When underwater, however, the lesions floated up, the surface structure clearly separated, and the base was clearly recognizable (Fig. 1b). Both lesions were semi-pedunculated-type polyps. Magnifying endoscopy with narrow-band imaging showed an irregular microsurface pattern. Water pressure was also used to clearly identify the polyp base and the demarcation line of the base was clearly confirmed. The lesions were diagnosed as cancer. Changing the patient’s position, combination with the underwater method, also may have contributed to observation of the base of the lesions. Both lesions were resected with an electrosurgical snare while a negative margin was confirmed (Fig. 1c). Spurting bleeding occurred from the resected surface of the distal lesion, and the water was quickly aspirated to allow hemostasis with clipping. The pathological results showed that most of the proximal lesion was hyperplastic lesion and part well-differentiated adenocarcinoma, whereas the distal lesion was mostly intramucosal, well-differentiated adenocarcinoma. Both lesions had not lymphovascular invasion, and the lateral and vertical margins were cancer-free (Fig. 2a,Fig. 2b).
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