Endoscopic Submucosal Dissection Using a Thulium Laser: Preliminary Results of a New Method for Treatment of Gastric Epithelial Neoplasia
Instead of endoscopic knives, a thin, flexible fiber is inserted through the working channel
of the endoscope. Acetic acid (1.5%) and indigo carmine dye are sprayed onto the lesion to
clarify the margin. Markings are made 10 mm outside the tumor margin using a laser fiber
with a power setting at 30 W. After marking, a mixture of sodium hyaluronate with indigo
carmine and epinephrine (1:25000) is injected into the submucosa outside the marking dots. A
circumferential mucosal incision and submucosal dissection are performed by a thulium laser
fiber with a power setting at 30 to 40 W. Activation of the laser beam is controlled by
stepping on a foot pedal. Hemostasis during procedure is also attempted using the thulium
laser. When hemostasis is not achieved properly, additional use of hemostatic forceps or a
hemoclip will be considered.
Observational Model: Case-Only, Time Perspective: Prospective
Curative resection rate
Joo Young Cho, M.D.
Digestive Disease Center, Soonchunhyang University Hospital
Korea: Institutional Review Board