A New Procedure of En-Bloc Endoscopic Mucosal Resection (EMR) Using Improved Papillotomy Knife (MUCOSECTOME)

Abstract

Backgrounds: En-bloc resection is beneficial for accurate histological assessment of resected specimen of endoscopic mucosal resection (EMR). Variable EMR methods were developed. Conventional EMR technique or technique using Cap device method (EMRC) is technically simple and convenient but with this procedure the size of specimen obtained from one-piece resection is very limited. Insulated tipped knife procedure (IT knife) has already reported and it is actually useful to some expert endoscopists of it, but sometimes difficult for general endoscopist to use it safely. We newly developed a safe and easy technique of the en-bloc EMR using an improved papillotomy knife (Mucosectome). Device and methods: Mucosectome is an electrosurgical device, which is improved papillotomy knife for EMR. Mucosectome is composed with flexible plastic shaft and cutting wire. Traction applied on the handle manipulates the tip of the Mucosectome to assist in the proper alignment of the cutting wire to the tissue and then procedure itself becomes safe. Results. 35 cases of early gastric cancer patients received EMR using Mucosectome. En bloc resection of the lesion succeeded in 32 cases. The size of the resected specimen varied 20 to 65mm. Dissection of the submucosa was very easily and fastly carried out. Minor bleeding including oozing occurred in 14.2% and no perforation encountered. Conclusion: Here we present a new method of EMR using improved papillotomy knife (Mucosectome), which can realize safer, easier, and less time-consuming EMR compared to previous methods.