title: Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer.
abstract: BACKGROUND
  EMR now is accepted as a minimally invasive treatment for early stage gastric cancer. However, the endoscopic approach sometimes is limited by the size and location of the tumor. The technique and early results of percutaneous, traction-assisted EMR for resection of larger early stage gastric cancers is described.
  
  
  METHODS
  EMR, by using an insulation-tipped electrosurgical knife, was performed with the simultaneous assistance of laparoscopy devices. A small snare was introduced into the gastric lumen through a gastric port (2-mm diameter) to grasp and pull the EGC away from the muscularis propria to facilitate resection.
  
  
  RESULTS
  The technique was performed successfully in our endoscopic suite in the first patient under general anesthesia and the remaining seven under conscious sedation. Tumors situated in any part of the stomach could be reached with percutaneous assistance, and this facilitated en bloc resection of large specimens (mean size 50 mm). The procedure was performed in about 60 minutes. Seven patients (88%) resumed eating 1 or 2 days after surgery. All patients were discharged after 1 week without complication.
  
  
  CONCLUSIONS
  Percutaneous, traction-assisted EMR is useful for resection of large lesions en bloc and can be performed easily and safely under direct vision.
authors.affiliation: Center for Digestive Diseases, Tonan Hospital, Sapporo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kondo
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kozu
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fujishiro
authors.forename: Daizo
authors.initials: D
authors.lastname: Saito
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000368:Aged; D004598:Electrosurgery / Q000295:instrumentation*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D013525:Surgical Instruments