Kd 650l

All patients received general anesthesia and endotracheal intubation. ER was performed using a dual knife (KD-650L; Olympus, Tokyo, Japan), an insulated-tip knife (Erbe, Tübingen, Germany), or a combination. Other equipment included injection needles, hot biopsy forceps, metallic clips, snares, nylon loops, and an Over-the-Scope-Clip System (Ovesco Endoscopy, Tübingen, Germany). We measured the largest tumor diameter and classified the gGISTs using the modified National Institutes of Health (NIH) risk criteria.^{11 (link)}
Two types of ER were performed: endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR). These endoscopic techniques have been described in previous reports.^{12 (link),13 (link)}

A general anesthetic was administered to all the participants, and they all underwent endotracheal intubation. We used two ER techniques: ESD and endoscopic full-thickness resection (EFTR). ESD was used for the treatment of gGISTs that originated from the muscularis mucosa (MM) or muscularis propria (MP) and protruded into the lumen, whereas GISTs originating from deep to the MP that showed extraluminal growth and those that could not be separated from the serous layer during ESD were treated using EFTR. The ER procedures were performed as previously described.^{11 (link),12 (link)}Figure 1 illustrates the process of EFTR for gGISTs. We used a single-channel endoscope (GIF-Q260J, Olympus, Tokyo, Japan) with a transparent cap attached to the endoscope tip. The other equipment used included dual knives (KD-650L; Olympus, Japan), insulated-tip knives (KD-611L; Olympus), a high-frequency generator device (ERBE VIO 200D, Erbe Elektromedizin, Tübingen, Germany), a carbon dioxide insufflator, hot biopsy forceps, injection needles, metallic clips, over-the-scope-clips (OTSCs), and nylon loops.

ESD was performed using a Dual Knife (KD-650L; Olympus Medical Systems Corp., Tokyo, Japan), a Flex Knife (KD-630L; Olympus Medical Systems Corp.), an IT Knife (KD-610L; Olympus Medical Systems Corp.) or an IT Knife 2 (KD-611L; Olympus Medical Systems Corp.). For the submucosal injection solution, a 1:1 solution of 0.4 % sodium hyaluronate (MucoUp; Johnson & Johnson K. K., Tokyo, Japan) and glycerol (Chugai Pharmaceutical Co. Ltd., Tokyo, Japan) was injected into the submucosa using a 25-G injection needle (ImpactFlow; TOP Corp., Tokyo, Japan). A hemostatic forceps (Coagrasper; FD410LR; Olympus Medical Systems Corp.) was used for the prophylactic coagulation of blood vessels and hemostasis for intraoperative bleeding. A VIO300 D or ICC200 (ERBE Elektromedizin GmbH, Tübingen, Germany) was used as the high-frequency generator. All ESDs were performed by expert physicians who were board-certified gastroenterological endoscopists of the Japan Gastroenterological Endoscopy Society or by less-experienced physicians (i. e., those who had performed fewer than 50 ESD procedures) under the supervision of the expert physicians. An expert endoscopist took over when the procedural time was expected to exceed 2 hours or when complications such as perforation or respiratory depression occurred.