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DOI: 10.1055/a-2219-8130
Three-point traction method for endoscopic submucosal dissection using clip-with-thread and clip-with-silicon bands for large early gastric neoplasms
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Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric neoplasms (EGNs), and traction methods have been developed to make ESD safe and simple [1] [2] [3]. Applying appropriate traction provides better visibility of the submucosal layer and enables effective dissection [4] [5]. We developed a novel three-point traction (TPT) method using a combination of clip-with-thread and clip-with-silicon band for gastric ESD. Here, we present a successful case of TPT-ESD for a large EGN ([Fig. 1], [Video 1]).
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202401/thumbnails/10-1055-a-2219-8130_22211732.jpg)
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Qualität:
A 70-year-old woman underwent ESD for a 50-mm EGN on the greater curvature of the antrum. Marking dots and circumferential mucosal incisions were made around the lesions using an electrosurgical knife. Subsequently, TPT was performed on the lesions. A clip-with-thread was placed at the 6 o’clock position of the mucosal flap of the lesion ([Fig. 2] a). Next, a clip-with-silicon band was placed at the 5 o’clock position of the mucosal flap. The third clip was placed in the 7 o’clock position of the mucosal flap while hooking the band, allowing the thread to run underneath the silicon band ([Fig. 2] b, [Fig. 2] c). TPT force was achieved by pulling the thread using three clips ([Fig. 2] d), which provided a wide and clear view of the submucosal layer, enabling stable submucosal dissection. En bloc resection was achieved without complication.
![](https://www.thieme-connect.de/media/10.1055-s-00025476/202401/thumbnails/10-1055-a-2219-8130_22211733.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Compared with the conventional one-point-traction using a clip-with-thread, the TPT method provides a wide and clear view of the submucosal layer, elevating a larger area of the lesion and preventing the lesion from twisting during the latter part of dissection. The silicon band traction force generated by two clips in the 5 and 7 o’clock positions of the mucosal flap can bring the submucosal layer toward center, generating a synergistic effect with the TPT force. TPT- ESD can be a treatment option for EGN, particularly large lesions.
Publikationsverlauf
Eingereicht: 21. August 2023
Angenommen nach Revision: 16. November 2023
Artikel online veröffentlicht:
08. Januar 2024
© 2024. 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
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