Conscious transnasal hybrid endoscopic submucosal dissection?enables safe and painless en bloc resection in?elderly?patients?with early gastric cancer

摘要

Endoscopic submucosal dissection (ESD) is a technically demanding and time-consuming procedure, which is usually performed with the patient under sedation. It is associated, therefore, with some definite risks, especially in elderly pa- tients. Recently, hybrid ESD was developed as an alternative therapeutic technique for achieving safe, easy, and quick en bloc resection of superficial GI neoplasms.'* Additionally, a previous study reported the feasibility of gastric ESD with use of a small-caliber endoscope, which was inserted per- orally, as a countermeasure to overcome the narrow space? or for use of a traction-assisted device.’ Because of the lower likelihood of pain and gag reflex activation, small- caliber endoscopy by the nasal route can be performed without the patient under sedation. Although Nakamura et al’ reported the efficacy of transnasal ESD without sedation, the limited usefulness of the transnasal endoscope still remains problematic. Because of the narrow accessory channel, operators must manufacture their own devices to fit the size of the narrow channel. Under these circumstances, ultrathin endodevices for use in transnasal endoscopy have been newly introduced: Souten”” and Raicho (Kaneka Medics, Tokyo, Japan) (Figs. 1A and B). Using these devices, we performed transnasal hybrid ESD without sedation for the resection of superficial gastric neoplasms (Video 1, available online at www.VideoGIE.org) and confirmed whether either is tolerated for elderly patients with severe comorbidities.