Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video)

BackgroundEndoscopic submucosal dissection (ESD) is the standard of care for treating gastric intramucosal neoplasias in Japan. However, it is seldom performed in Western countries, mainly because it is technically very challenging. Several traction methods have been proposed to facilitate submucosal dissection, but they are usually not widely available or are difficult to apply.ObjectiveOur main aim was to evaluate the feasibility of a new method, the clip-band technique, for improving the visualization of the submucosal layer during ESD.DesignObservational, experimental, feasibility study conducted in a porcine model.SettingUniversity Hospital of the Canary Islands, Research Animal Laboratory.PatientsAnimal study.InterventionsAfter completion of the circumferential cutting, a clip-band traction system was applied.Main Outcome MeasurementsEfficacy and safety of the clip-band technique.ResultsEighteen ESDs performed in live domestic pigs were completed without any serious complications. The mean specimen size was 35.38 ± 12.17 mm, the mean cutting time was 13.06 ± 10.52 minutes, and the mean dissection time was 16.67 ± 9.01 minutes.LimitationsThe clip-band technique was not compared with the standard ESD technique.ConclusionsThis initial study shows that the clip-band traction technique is feasible and that it permits safe, effective, and relatively inexpensive gastric ESD.