Post written by Koichi Hamada, MD, from the Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima and the Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama.

This case study presents a series of patients with early gastric cancer undergoing endoscopic submucosal dissection (ESD) using a multibending endoscope (GIF-2TQ260M; Olympus Medical Corp, Tokyo, Japan). The multibending endoscope has 2 bends at its tip, making it easier to approach areas that would be challenging to approach with a conventional, single-bending endoscope. Further, after approaching the area, small adjustments can be made to the upward or downward angle of either bending sections of the endoscope; this ensures that the knife will approach the submucosa at an angle parallel to the muscle layer. In Case 1, initially, we used a conventional endoscope. The knife was at an adversarial angle to the muscle layer, and this had a high risk of muscle layer damage. By using the multibending endoscope, we were able to easily approach the dissection site and suitably orient the knife, so that it was nearly parallel to the muscle layer.

The GIF-2TQ260M is a 2-channel endoscope. In Case 2, we considered this 2-channel functionality when determining the best method for developing a good visual field. In the ESD procedures, we extended the knife through the left channel when moving towards the right, and vice versa. Using this method expands our visual field in the direction of the cut, which further facilitates our ability to visualize the vasculature and the muscle layer.

Further, when using a conventional endoscope, inserting devices (knife, hemostatic forceps) narrows the channel of the endoscope and reduces suction power. However, with a 2-channel endoscope, suction is performed with the left channel, meaning that the insertion of devices into the right channel of the endoscope will not reduce suction; this enables rapid deaeration and aspiration of blood.

The multibending endoscope will be especially useful for the lesions at the lesser curvature of the stomach, anterior wall of the gastric body, fundus, and angulus of the stomach that are unreachable by a conventional endoscope. However, the multibending endoscope will be useful for any part of the stomach except narrow spaces, such as the pyloric ring and esophagogastric junction. We believe that the use of a multibending endoscope for ESD will enable safer and faster treatment of patients.

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