Abstract
The recent development of a high-quality videocolonoscope together with improved bowel preparation using whole-gut irrigation 1 Davis GR Santa Ana CA Morawski SG Fordtran JS. Development of large solution associated with minimal water and electrolyte absorption of secretion. Gastroenterology. 1980; 78: 991-995 PubMed Scopus (463) Google Scholar have made it possible to identify small or nonpolypoid neoplastic lesions that may have been previously overlooked at colonoscopy. However, complete removal of these nonpolypoid neoplastic lesions by conventional snare polypectomy is difficult due to their flat morphology. Although these flat lesions have been treated by endoscopic mucosal resection (EMR) techniques, 2 Yokota T Sugihara K Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions. Dis Colon Rectum. 1994; 37: 1108-1111 Crossref PubMed Scopus (143) Google Scholar , 3 Deyle P Largiader F Jenny S Fumagalli I. A method for endoscopic electrosection of sessile colonic polyp. Endoscopy. 1973; 5: 38-40 Crossref Scopus (190) Google Scholar , 4 Kudo S. Endoscopic mucosal resection of flat and depressed type of early colorectal cancer. Endoscopy. 1993; 25: 455-461 Crossref PubMed Scopus (757) Google Scholar incomplete removal 2 Yokota T Sugihara K Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions. Dis Colon Rectum. 1994; 37: 1108-1111 Crossref PubMed Scopus (143) Google Scholar and local recurrence 5 Walsh RM Ackroyd FW Shellito PC. Endoscopic resection of large sessile colorectal polyps. Gastrointest Endosc. 1992; 38: 308-309 Google Scholar are frequently observed after conventional EMR. To completely remove a large lesion in a single fragment, we used a new EMR procedure using an insulation-tipped electrosurgical (IT) knife, which was developed by Hosokawa and Yoshida 6 Hosokawa K Yoshida S. Recent advances in endoscopic nucosal resection for early gastric cancer. Jpn J Cancer Chemother. 1998; 25 ([in Japanese with English abstract]): 483 Google Scholar in 1995, and obtained good results. We describe here our initial experience with the IT knife technique in 2 patients with rectal nonpolypoid neoplastic lesions.
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