ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER IN A PATIENT WITH SITUS INVERTUS TOTALIS

Abstract

The patient was an 88-year-old man who had been diagnosed with complete situs inversus when he was young. Upper gastrointestinal endoscopy revealed a large 20 mm lesion suggestive of 0-Ⅱc type early-stage gastric cancer in the posterior wall of the lesser curvature of the stomach's antrum. Since the extension of the antrum where the lesion was found was poor when the patient was placed in the left lateral recumbent position, endoscopy was reperformed with the patient in the right lateral recumbent position. In this position, the extension of the antrum was maintained in comparison with the left lateral recumbent position. However, when patients are placed in the right lateral recumbent position, the surgeon is required to acquire a different position as well as a different arrangement of surgical instruments. Hence, performing ESD, which requires delicate endoscopic manipulation, may be challenging in such an unsuitable setting. Thus, ESD was performed with the patient in the left lateral recumbent position. No complications occurred during ESD, and an en-bloc resection of the lesion was feasible in this patient positioning. This study suggests that determining the left or right lateral recumbent position through preoperative simulation is useful when ESD is performed on patients with early-stage gastric cancer and complete situs inversus.