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DOI: 10.1055/a-2178-4220
A new treatment method for patients with cancer that cannot be resected en bloc by endoscopic submucosal dissection: the monorail method with clip-line traction
Endoscopic submucosal dissection (ESD) is a safe endoscopic treatment for early-stage cancer of the esophagus, stomach, duodenum, and colon [1]. However, there are some cases in which ESD is difficult to resect en bloc owing to the location and extent of the lesion, fibrosis, and postoperative effects of the procedure. For these difficult cases, ESD may cause perforation, making en bloc resection difficult, and there are reports of treatment methods using various traction devices [2] [3]. The method presented here is to pull the lesion with a clip line, and then pass the thread through a snare from outside the intestinal tract to reach the lesion like a monorail.
The patient was a 73-year-old woman with a 0-IIa lesion measuring almost 100 mm, found in the gastric fornix position. In this case, using the dual knife and Hook knife made the greater curvature side difficult to approach and difficult to detach owing to high respiratory variability. We changed to an IT knife, but most of the lesion was resected, making it difficult to apply tension and difficult to approach, making ESD difficult. Therefore, we first attached a clip line to the lesion ([Fig. 1]). Traction was applied to the oral side of the lesion. Once the endoscope was removed, the snare was slightly widened from the tip, and a string was inserted through it ([Fig. 2], [Fig. 3]). The endoscope was inserted through the clip line like a monorail to the lesion ([Fig. 4]). The snare was opened, and the lesion was resected en bloc while traction was applied with a clip line ([Fig. 5]). A complete resection with no major complications and residuals was possible ([Video 1]).
Video 1 A new treatment method for patients with cancer that cannot be resected en bloc by endoscopic submucosal dissection: the monorail method with clip-line traction.
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In conclusion, the monorail method allows safe en bloc resection and is considered a new treatment method for difficult ESD cases.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB
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Publication History
Article published online:
06 October 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Suzuki H, Takizawa K, Hirasawa T. et al. Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: ‘Real-world evidence’ in Japan. Dig Endosc 2019; 31: 30-39
- 2 Abe S, Wu SYS, Ego M. et al. efficacy of current traction techniques for endoscopic submucosal dissection. Gut Liver 2020; 14: 673-684
- 3 Tsuji K, Yoshida N, Nakanishi H. et al. Recent traction methods for endoscopic submucosal dissection. World J Gastroenterol 2016; 22: 5917-5926