title: A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection.
abstract: BACKGROUND
  Compared with conventional EMR, endoscopic submucosal dissection (ESD) has a higher en bloc resection rate and complete resection rate, regardless of tumor size, in treating gastric neoplasms. However, ESD leads to more complications, such as bleeding or perforation, and, in particular, needs more procedure time than a conventional EMR.
  
  
  OBJECTIVE
  To report a new technique for ESD, peroral traction-assisted ESD with suture material, to perform easier and more rapid procedures in treating gastric neoplasms and to report the technique's early results.
  
  
  METHODS
  A case series.
  
  
  METHODS
  A tertiary medical center.
  
  
  METHODS
  A total of 15 patients with gastric adenomas or early gastric cancers larger than 10 mm in diameter were consecutively enrolled. After marking around the periphery of the lesion, submucosal injection, followed by circumferential mucosal incision with a Flex-knife and an insulation-tipped knife, was conducted. After that, one hemostatic clip, tied by using a white silk suture, was applied at a site of the lesion suitable for oral traction. During submucosal dissection, the applied suture material was pulled to the oral side. Additional tractions were applied as needed.
  
  
  METHODS
  En bloc resection rate, procedure time, complications.
  
  
  RESULTS
  All lesions were resected en bloc with free lateral and vertical margins by using this technique. The mean longest lesion size and specimen size were 18.1 mm (range 11-28 mm) and 43.7 mm in diameter (range 25-64 mm), respectively. The mean procedure time was 49.6 minutes (range 28-90 minutes). There was no significant bleeding that required blood transfusion or perforation related to the procedures.
  
  
  CONCLUSIONS
  Single endoscopist, small patient number.
  
  
  CONCLUSIONS
  Peroral traction-assisted ESD with suture material is useful in treating gastric neoplasms located in various regions of the stomach. It may make ESD procedures easier, faster, and safer under better direct vision of the submucosal layer.
authors.affiliation: Department of Internal Medicine, Chungbuk National University, College of Medicine and Medical Research Institute, Hungdukgu, Cheongju, Korea. wjjeon@chungbuk.ac.kr
authors.forename: Won Joong
authors.initials: WJ
authors.lastname: Jeon
authors.forename: Il Young
authors.initials: IY
authors.lastname: You
authors.forename: Hee Bok
authors.initials: HB
authors.lastname: Chae
authors.forename: Seon Mee
authors.initials: SM
authors.lastname: Park
authors.forename: Sei Jin
authors.initials: SJ
authors.lastname: Youn
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001707:Biopsy, Needle; D004210:Dissection / Q000379:methods; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology* / Q000601:surgery; D020699:Gastroscopes; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009055:Mouth; D009367:Neoplasm Staging; D011379:Prognosis; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome