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

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Conscious transnasal hybrid endoscopic submucosal dissection enables safe and painless en bloc resection in elderly patients with early gastric cancer Yohei Minato, MD, Eiji Sakai, MD, PhD, Ken Ohata, MD VideoGIE Volume 4, Issue 4, Pages 157-158 (April 2019) DOI: 10.1016/j.vgie.2018.12.013 Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 1 Ultrathin-type endodevices that can be used in transnasal endoscopy. A, Souten (Kaneka Medics, Tokyo, Japan). A 1.5-mm needle-knife with a knob-shaped tip attached to the top of the snare loop. The diameter of the insertion sheath part is 2.35 mm. B, Raicho (Kaneka Medics, Tokyo, Japan). A rotatable monopolar-type hemostatic device. The diameter of the insertion sheath part is 2.3 mm. C, Handmade distal attachment with transparent tape wound on the tip of the transnasal endoscope. VideoGIE 2019 4, 157-158DOI: (10.1016/j.vgie.2018.12.013) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions

Figure 2 Hybrid endoscopic submucosal dissection (ESD). A, Lesion located in the antrum. B, Endoscopy by the transnasal approach with use of a thin-type scope without sedation. C, A circumferential incision is made with the Souten tip. D, Lesion tied up with the snare part of the Souten. E, Ulcer floor after hybrid ESD. F, Resected specimen; en bloc resection was achieved. G, Microscopic view of the gastric polyp. VideoGIE 2019 4, 157-158DOI: (10.1016/j.vgie.2018.12.013) Copyright © 2019 American Society for Gastrointestinal Endoscopy Terms and Conditions