Gel immersion endoscopic mucosal resection in early gastric cancer with bleeding: A case report.

ABSTRACT

Gel immersion endoscopy was developed by Yano for the treatment of bleeding. In this case, we performed gel immersion endoscopic mucosal resection to treat a bleeding gastric cancer. An 80-year-old man, with chronic renal failure and on aspirin treatment for ischemic heart disease, underwent endoscopic treatment for multiple early gastric cancers on the anterior and posterior walls of the pyloric ring. An endoscopic submucosal dissection was performed for gastric cancer on the anterior wall; however, the removal of the cancer on the posterior wall was complicated by tumor prolapse and bleeding. Gel formulation (VISCOCLEAR® Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan) was used to immerse the bleeding tumor and subsequently facilitate the endoscopic mucosal resection. Various factors, such as the use of antithrombotic medication and underlying renal disease, can increase the risk of bleeding during endoscopic gastric cancer resection. If bleeding persists, the resection margin becomes obscured. Gel formulations, such as VISCOCLEAR®, can be applied to control bleeding and improve visibility. In this case, gel immersion was useful for endoscopic mucosal resection of the bleeding tumor. The use of gel immersion endoscopic resection should be considered for the treatment of early gastric cancer, however further cases should be evaluated.