In an 82-year-old woman, two 20-mmpolyps were identified at the greater curvatureof the middle stomach body duringesophagogastroduodenoscopy witha high-definition magnifying endoscope(GIF-H290Z, Olympus, Tokyo, Japan).Both lesions were in close contact withthe stomach wall due to the influence ofgravity, and their morphology could notbe accurately determined (?Video 1,?Fig. 1a). When underwater, however,the lesions floated up, the surface structureclearly separated, and the base wasclearly recognizable (?Fig. 1b). Both lesionswere semi-pedunculated-typepolyps. Magnifying endoscopy with narrow-bandimaging showed an irregularmicrosurface pattern. Water pressurewas also used to clearly identify thepolyp base and the demarcation line ofthe base was clearly confirmed. The lesionswere diagnosed as cancer. Changingthe patient’s position, combinationwith the underwater method, also mayhave contributed to observation of thebase of the lesions. Both lesions were resectedwith an electrosurgical snarewhile a negative margin was confirmed(?Fig. 1c). Spurting bleeding occurredfrom the resected surface of the distal lesion,and the water was quickly aspiratedto allow hemostasis with clipping. Thepathological results showed that mostof the proximal lesion was hyperplasticlesion and part well-differentiated adenocarcinoma,whereas the distal lesionwas mostly intramucosal, well-differentiatedadenocarcinoma. Both lesions hadnot lymphovascular invasion, and the lateraland vertical margins were cancerfree(?Fig. 2a, ?Fig.2b).
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