Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors: Personal experience and literature review

Figure 1 Preoperative endoscopy of prepyloric early gastric cancer. A: Endoscopy; B: Virtual chromoendoscopy; C: Endoscopic ultrasound.

Figure 2 Endoscopic injection of indocyanine green at cardinal points 1 cm from the margins of a prepyloric early gastric cancer lesion. A: First injection of indocyanine green (ICG); B: Second injection of ICG; C: Cardinal points of the lesion injected with ICG.

Figure 3 Sentinel lymph node biopsy. A: Level 4 d node; B: Level 4 d fluorescent node with near-infrared vision.

Figure 4 One-step nucleic acid amplification assay. A-F: Lymph nodes were prepared and placed in homogenized lysis buffer (Lynorhag; Sysmex) and then centrifuged. CK19 mRNA was extracted from the lysate and analyzed by reverse transcription-loop-mediated isothermal amplification in the RD-100i system (Sysmex) using the Lynoamp (Sysmex) reagent kit[59].

Figure 5 Laparoscopic and robotic surgical incision and reconstruction of the external gastric wall. A and B: Incision, representative views; C and D: Reconstruction, representative views.

Figure 6 Endoscopic full thickness resection of early gastric cancer using the non-exposed endoscopic wall-inversion surgery procedure. A: Mucosal markings placed around the tumor; B: Endoscopic incision of the internal layers of the gastric wall; C: Specimen.