Dissection of the fibrosis is made along an imaginary line at the top of the “mountain” which is the pulled up muscularis. PCM has two advantages including maintenance of the thick GDC 0068 submucosal layer with a minimal mucosal incision preventing leakage of injection solution, and providing good traction, thus stretching the submucosal tissue and facilitating the submucosal dissection. SUBJECT: From September 2009 to December 2013,

88 sessile or subpedunculated lesions >20 mm in size were treated by ESD at Jichi Medical University Hospital. PCM was performed for 29 lesions (P-group) and conventional ESD was performed for 59 lesions (C-group). Results: The mean tumor size was 44.9 mm in the P-group and 41.6 mm in the C-group. The F2 rate (Hiroshima University Classification for degree of submuscosal fibrosis, =F2/F0+F1) was higher in the P-group (51.7% vs 28.8%, p = 0.04). En-bloc resection rate and resection speed (resection area/time) were not significantly different in the two groups. Perforation rate was almost the same in both groups (10.3% vs 10.2%). Conclusion: PCM had outcomes similar to ESD, even when

a significantly greater number of lesions had submucosal fibrosis, suggesting that PCM may be a superior technique. These results support further study of this technique. Key Word(s): 1. ESD Pocket-Creation method Presenting Author: YAMAYO TADA Additional Authors: TOSHIYASU IWAO, TOMOKI KYOSAKA, KATSUYA HIROSE Corresponding Author: YAMATO TADA Affiliations: Aidu Chuo Hospital, Aidu this website Chuo Hospital, Aidu Chuo Hospital Objective: A 79-year-old man who had alcoholic pancreatitis was diagnosed with a pancreatic pseudocyst around the tail of the pancreas. Methods: As the pseudocyst was infected, we performed endoscopic ultrasound-guided cyst drainage (EUS-CD). EUS showed a large blood vessel in the puncture route, and we therefore made the puncture MCE taking care to avoid the vessel. A guidewire was left in place through the route, and we attempted to dilate it with a diathermic sheath; however, we could not move the sheath smoothly

owing to resistance. Electrification for 20–30 s was required to dilate the whole route. After we successfully expanded the route and passed the diathermic sheath, we completed the procedure with a nasal cyst drainage tube left in place. At 2 d after the procedure, we detected bloody drainage from the tube, and After 7 d, the patient vomited blood. We performed upper gastrointestinal endoscopy to stop the bleeding and found that the hole of the puncture was the source of the bleeding; however, we could not stop the bleeding via the endoscope. We then performed angiography and embolized the splenic artery using coils. To clarify the process of damage, we performed an experiment for examining vascular injury by a diathermic sheath using uncured ham and porcine blood vessels.