Usefulness of gel immersion endoscopy for endoscopic resection in stomachs with residue

Background and Aims

EMR and endoscopic submucosal dissection are widely used for treating intramucosal gastric neoplasms. However, securing a clear visual field in a stomach with residue is challenging. In this article, we present 2 cases in which tumors were endoscopically resected by securing the visual field using the gel immersion method in remnant stomachs after proximal gastrectomy with residue.

Methods

The gel immersion method is a technique in which a transparent, viscous gel is injected into the lumen to secure the visual field. The viscous gel displaces blood and residue, allowing for a clear view. Therefore, we could perform efficient endoscopic procedures calmly. We also used the dedicated valve to add the gel while we inserted devices through its accessory channel.

Results

In both cases, the gel immersion method successfully displaced food residue, providing a clear visual field and enabling precise mucosal incision and resection. In the first case, we achieved en bloc resection in a 71-year-old man with a 5-mm adenoma by using gel immersion EMR. In the second case, a 74-year-old man with a 12-mm intramucosal adenocarcinoma underwent gel immersion endoscopic submucosal dissection, which facilitated an accurate incision line and effective coagulation. Both patients had negative resection margins, and no adverse events were observed.

Conclusions

The gel immersion method effectively improved visualization in a stomach with residue, enhancing the safety and precision of endoscopic resection.