Deterioration of visibility because of blood and adipose tissue makes endoscopic submucosal dissection (ESD) difficult, and it is sometimes necessary to withdraw the endoscope and clean the lens. We hypothesized that coating the lens with a liquid ceramic material would prevent deterioration of visibility.
This case report describes ESD for a gastric tumor with the use of a liquid ceramic coating (Hycera; Miyazaki Chemical Co, Ltd, Kyoto, Japan) on the endoscope lens. Hycera is a liquid ceramic composed mainly of silanole and silicon dioxide and is not absorbed by the human body. It is usually used for digital displays, showcases for food, and other purposes. At this time, Hycera has not been approved for medical products. Therefore, this study was approved by the Institutional Review Board of our hospital (study registration: UMIN 000029793).
A 75-year-old man was found to have an early gastric cancer in the lesser curvature of the upper part of the stomach body, which had severe fibrosis caused by previous ESD. The tumor was marked with a needle-knife (KD-1L-1; Olympus Co, Tokyo, Japan), and a small incision was made by the needle-knife after the injection of saline solution diluted with sodium hyaluronate (MucoUp; Boston Scientific Co, Tokyo, Japan) into the submucosa. After circumferential mucosal cutting with an insulated-tip knife (IT knife-2, KD-611L; Olympus), Submucosal dissection was performed (Fig. 1 and Video 1, available online at www.VideoGIE.org). Despite hypervascularity and abundant adipose tissue, the lens of the endoscope was cleaned only once during the procedure. The patient was discharged without adverse events.
Figure 1.
A, Endoscopic image of lesion in the lesser curvature of the upper part of the stomach body. B, Differences in contact angle: left, coated with liquid ceramic; right, not coated. C, Endoscopic image at 30 minutes from incision. D, At 45 minutes from incision. E, At 60 minutes from incision. F, At 120 minutes from incision. G, At 180 minutes from incision. H, At 240 minutes from incision. I, Endoscopic view after endoscopic submucosal dissection, showing a large artificial ulcer.
In conclusion, this study clearly demonstrates the feasibility of using a liquid ceramic coating on the endoscope lens in gastric ESD. We believe that this material prevents deterioration of visibility and facilitates other procedures, including other endoscopic examinations and laparoscopic surgery.
Detailed testing of the effects of this material on the human body has not been done, and there is no approval of its use for this purpose by the U.S. Food and Drug Administration. In addition, details of its effects on the endoscope lens are unknown. This study was conducted with approval from our Institutional Review Board and consent from the patient. To make this material popular in the future, corporate efforts are necessary, and we are currently working on it.
Disclosure
All authors disclosed no financial relationships relevant to this publication.
Footnotes
Written transcript of the video audio is available online at www.VideoGIE.org.
Supplementary data
Endoscopic submucosal dissection for gastric cancer in the lesser curvature of the upper part of the stomach body by use of a liquid ceramic coating.
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Supplementary Materials
Endoscopic submucosal dissection for gastric cancer in the lesser curvature of the upper part of the stomach body by use of a liquid ceramic coating.