Well done to everyone as you all spotted the cancer! The early gastric cancer is not easy to see on the initial video and I have uploaded a second clip showing the appearances after dye spray.
The lesion has now been scheduled for endoscopic resection. As there is no deep, central ulceration and the lesion is “smallish”, I think that the lesion will turn out to be intramucosal. It’s probably best removed by ESD although it would also be possible to remove it using an Olympus cap or the Cook Duette banding device or the “pull within the snare” technique. After all, almost all lesions, perhaps with the exception of flimsy villous adenomas, can be removed by the “pull-within-the-snare” technique.
To the patient, I quoted a 1:30 risk of late bleeding and a 1:50 risk of gastric perforation, which would be easily fixed with clips. As I only do about 1 ESD/week I am somewhat rusty and resecting this lesion may take me an hour! If the patient is not fit for a GA and not unusually stoical, the “pull-within-the-snare” technique will have the lesion off within 5-10 minutes.
In the event, the patient was unfit for a GA but could tolerate a hybrid ESD whereby I cut around the lesion using a hook knife and then placed a snare around it. The video capture (the last clip) missed the placing of the snare but did capture the closure of the mucosal defect using 15 clips and an Olympus "ligating device".
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