Gif h290z

Instruments used in this study were magnification video-endoscope systems (GIF-H260Z or GIF-H290Z; Olympus Medical Systems Co, Ltd, Tokyo, Japan) and a standard optical video-endoscope system (EVIS LUCERA ELITE system; Olympus Medical Systems). With each system, one light source projects standard broadband white light or, following insertion of an NBI filter into the light path, narrow-band short wavelength light.

ESD was performed with either a single-channel or a 2-channel endoscope (GIF-Q260J, GIF-H290Z, and GIF-2TQ260M; Olympus, Tokyo, Japan), and with either a FlushKnife BT (DK2618JB; Fujifilm, Tokyo, Japan) or a DualKnife (KD-650L; Olympus, Tokyo, Japan) as the electrosurgical knife. ESD procedures were performed predominantly by four expert endoscopists who have performed more than 300 gastric ESDs. For the procedure, markings were made with the electrosurgical knife around the lesion. Sodium hyaluronate was injected into the submucosal layer, and a circumferential mucosal incision outside the markings was made with the electrosurgical knife. Subsequently, submucosal dissection of the lesion was performed, and pre-coagulation of visible vessels with hemostatic forceps (FD-230U or FD-410LR; Olympus, Tokyo, Japan) was performed during the submucosal dissection. After removal of the lesion, all visible vessels on the artificial ulcer bed were coagulated with hemostatic forceps. Neither endo-clip suturing and poly-glycolic acid sheet patching was done for post-ESD ulcer in this study.

All patients underwent pretreatment endoscopic examinations using endoscopes that provide narrow-band imaging with magnifying endoscopy (GIF-H260Z or GIF-H290Z; Olympus Medical Systems Corporation, Tokyo, Japan) to accurately confirm tumor margins. All procedures were performed under conscious sedation using midazolam or propofol and pentazocine. A single-channel endoscope with water jet (GIF-Q260J; Olympus, Tokyo, Japan) or a 2-channel multi-bending endoscope (GIF-2TQ260 M; Olympus) was used with a high-frequency power supply unit (VIO300D, ICC200; ERBE, Tübingen, Germany or PSD60; Olympus, Tokyo, Japan) for electrocoagulation. Gastric ESDs were performed using a conventional procedure. After marking around the tumor and injecting saline or 10% glycerin solution mixed with sodium hyaluronate (MucoUp; Johnson & Johnson Medical Company, Tokyo, Japan), we started mucosal incision using a Dual knife (Olympus Medical Systems, Co. Tokyo. Japan) and performed submucosal dissection using insulated-tip knife-2 (Olympus Medical Systems, Co. Tokyo. Japan) and Dual knife. The remaining visible blood vessels in the ESD artificial ulcer were cauterized using hemostatic forceps (Coagrasper; Olympus Medical Systems Co. Tokyo, Japan). After resection, we dispersed a mixture containing aluminum hydroxide gel, liquid magnesium hydroxide, and 10000 U thrombin (approximately 100 mL).

ESD was performed with a single channel endoscope (GIF-H290Z; Olympus, Tokyo, Japan). We used a dual knife (KD-650; Olympus) as the cutting device, and an electrical current was applied using an electrosurgical generator (VIO300D; ERBE Elektromedizin GmbH, Tubingen, Germany). Visible vessels were heat-coagulated using hemostatic forceps (Coagrasper G; FD-412LR; Olympus).
Major and minor axes of ESD-induced artificial ulcers were endoscopically measured with measurement forceps (M2-4K; Olympus) at 1 day and 1, 2, 4, and 8 weeks after ESD. The area of artificial ulcers was calculated as the area of a prolate ellipse.