Aggressive endoscopic mucosal resection in the upper GI tract - Hook knife EMR method.

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• En bloc resection of large gastrointestinal lesions is challenging with conventional endoscopic mucosal resection (EMR) techniques.
• Accurate histological assessment of lesion size, lateral spread, and invasion depth is crucial for effective cancer treatment planning.

Purpose of the Study:

• To introduce and evaluate a novel EMR method, the 'Hook knife' technique, for en bloc resection of larger gastrointestinal lesions.
• To assess the feasibility and efficacy of the 'Hook knife' method for achieving complete resection and facilitating precise histological analysis.

Main Methods:

• The 'Hook knife' method involves marking the lesion, submucosal injection of a glycerol diluted epinephrine solution, mucosal incision with a needle knife, and submucosal dissection using a hook-type knife.
• This technique facilitates en bloc resection of lesions, including those ≥70 mm in size.

Main Results:

• The 'Hook knife' EMR method successfully enabled en bloc resection of large lesions (≥70 mm).
• This technique allows for more precise histological examination of lateral spreading and invasion depth.
• The method establishes aggressive endoscopic mucosal resection for improved patient management.

Conclusions:

• The 'Hook knife' method is a novel and effective EMR technique for the en bloc resection of larger gastrointestinal lesions.
• This approach enhances the accuracy of histological staging, supporting more aggressive and precise treatment strategies.
• The developed EMR method offers a significant advancement in endoscopic surgical capabilities for gastrointestinal pathology.