title: Endoscopic submucosal dissection with sheath-assisted counter traction using a novel sheath for early gastric cancers.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is technically demanding and requires considerable skill. We previously described sheath-assisted counter traction ESD that uses simple materials and methods to improve cutting line visualization. We recently improved counter-traction of the submucosal layer using a novel chemically treated sheath that reduces slippage and maintains traction, and investigated the utility of the novel sheath for ESD.
  
  
  METHODS
  Forty-three and 25 consecutive patients with early gastric carcinomas were treated by standard ESD and traction ESD assisted with novel sheaths, respectively. The mean duration of procedures relative to tumor size and location, as well as complications after ESD between the two groups were compared.
  
  
  RESULTS
  The mean duration of ESD procedures for lesions =20mm in diameter was significantly reduced using the novel sheath. The mean duration of procedures for all locations of resected tumors in the stomach was significantly reduced using the novel sheath. However, no perforation and delayed bleeding developed after treatment with the novel sheath.
  
  
  CONCLUSIONS
  Sheath-assisted counter traction ESD by the novel sheath was technically simpler and thus less time-consuming regardless of the location of lesions, especially when =20mm in diameter. The traction ESD with the novel sheath is safe and not invasive, and it can be universally applied to standard ESD.
authors.affiliation: Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Hijikata
authors.forename: Naotaka
authors.initials: N
authors.lastname: Ogasawara
authors.forename: Makoto
authors.initials: M
authors.lastname: Sasaki
authors.forename: Mari
authors.initials: M
authors.lastname: Mizuno
authors.forename: Ryuta
authors.initials: R
authors.lastname: Masui
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kondo
authors.forename: Shinya
authors.initials: S
authors.lastname: Izawa
authors.forename: Yoshitsugi
authors.initials: Y
authors.lastname: Ito
authors.forename: Hisatsugu
authors.initials: H
authors.lastname: Noda
authors.forename: Kunio
authors.initials: K
authors.lastname: Kasugai
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013523:Surgical Equipment; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden