Abstract

It is difficult to perform endoscopic mucosal resection (EMR) in case of early gastric cancer involving duodenal bulb. To achieve complete resection, we applied a new method: that is, EMR with an insulation-tipped diathermic knife (IT knife) was peformed by the retroflexion of endoscope in the bulb. This method was tried in 4 patients. For the antral side of the tumor, EMR was done using a needle knife or IT knife. The duodenal side of the tumor was resected by IT knife with the retroflexion of endoscope in the bulb. The complete resection was performed in 2 patients, an incomplete resection in one patient, and the laparoscopic subtotal gastrectomy was performed in the remaining one patient because reconstruction of partitional resection was very difficult and adenocarcinoma was found to involve the muscularis mucosa. We think that EMR with IT knife by endoscopic retroflexion in the bulb is effective for some cases of early gastric cancer involving the duodenal bulb. (Korean J Gastrointest Endosc 2005;31:166⁣170)

• Keywords: Early gastric cancer, Mucosectomy, Duodenal invasion