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DOI: 10.1055/a-2512-4706
Pre-incision traction method using clip-and-thread for gastric endoscopic submucosal dissection
Gastric endoscopic submucosal dissection (G-ESD) has become a widely accepted and well-established treatment modality [1]. However, G-ESD can be technically challenging depending on the lesion’s location owing to the difficulty in creating a mucosal flap. This can increase procedure time and lead to unintentional bleeding during mucosal incision and submucosal dissection. To address these challenges, we present a new method called the “pre-incision traction method” for G-ESD.
A 67-year-old man presented with early gastric cancer located on the greater curvature of the middle gastric body ([Fig. 1]). A semi-circumferential mucosal incision on the oral side was performed using the ITknife 2 (Olympus, Tokyo, Japan) ([Fig. 2] a). Subsequently, a threaded clip (EZ clip; Olympus) was applied to the anal side where the mucosal incision had not yet been completed ([Fig. 2] b). When mucosal incision on the anal side of the clip was performed with FlushKnife BT-S (Fujifilm, Tokyo, Japan), a mucosal flap was immediately created, providing an excellent field of view and facilitating submucosal dissection ([Fig. 2] c). The dissection speed was also improved due to the adequate tension provided by the clip. The threaded clip did not interfere with subsequent procedures, and a constant tension was kept by pulling the thread. En bloc resection was achieved without any complications ([Fig. 2] d, [Video 1]).
Quality:
The traction methods reported to date typically involve a full circumferential incision to facilitate submucosal dissection [2]. Our novel “pre-incision traction method” aims to simplify the creation of the mucosal flap and maintain a clear field of view, thereby making G-ESD safer and more time efficient. While similar traction methods have been reported for colorectal ESD [3], there have been no such reports for G-ESD. We are currently planning a feasibility study to investigate the efficacy and safety of this new method.
Endoscopy_UCTN_Code_CPL_1AH_2AZ_3AD
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Publication History
Article published online:
28 January 2025
© 2025. 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/).
Georg Thieme Verlag KG
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References
- 1 Ono H, Yao K, Fujishiro M. et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc 2021; 33: 4-20
- 2 Yoshida M, Takizawa K, Suzuki S. et al. Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 2018; 87: 1231-1240
- 3 Ide D, Ohya TR, Saito S. et al. Clinical utility of the pocket-creation method with a traction device for colorectal endoscopic submucosal dissection. Surg Endosc 2021; 35: 2110-2118