Endoscopic submucosal dissection with internal traction for early gastric cancer (with video).
BACKGROUND
EMR techniques have high success rates for treating small lesions of the upper-GI tract; however, tumors larger than 15 mm are frequently removed by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen.


OBJECTIVE
To describe a simple technique of using internal traction to facilitate endoscopic submucosal dissection (ESD) procedures in the excision of large, early gastric cancers.


METHODS
Case series.


METHODS
A tertiary medical center in Taiwan.


METHODS
Eight patients with early gastric cancers larger than 20 mm underwent ESD.


METHODS
A standard hemoclip modified with surgical suture was used to provide traction to improve visualization of the dissection plane during ESD.


METHODS
Proportion with complete en bloc resection.


RESULTS
En bloc resection of the lesion was achieved in 8 patients. One patient underwent additional surgery because an adequate safe margin was not obtained by ESD.


CONCLUSIONS
One endoscopist performed all procedures, and only 8 patients were studied in an uncontrolled manner.


CONCLUSIONS
The internal traction method appears to facilitate en bloc ESD of early gastric cancers larger than 20 mm.
Taipei, Taiwan.
Peng-Jen
PJ
Chen
Heng-Cheng
HC
Chu
Wei-Kuo
WK
Chang
Tsai-Yuan
TY
Hsieh
You-Chen
YC
Chao
D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*