Endoscopic submucosal dissection with internal traction for early gastric cancer (with video)

BackgroundEMR techniques have high success rates for treating small lesions of the upper-GI tract; however, tumors larger than 15 mm are frequently removed by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen.ObjectiveTo describe a simple technique of using internal traction to facilitate endoscopic submucosal dissection (ESD) procedures in the excision of large, early gastric cancers.DesignCase series.SettingA tertiary medical center in Taiwan.Patients and MethodsEight patients with early gastric cancers larger than 20 mm underwent ESD.InterventionsA standard hemoclip modified with surgical suture was used to provide traction to improve visualization of the dissection plane during ESD.Main Outcome MeasurementsProportion with complete en bloc resection.ResultsEn bloc resection of the lesion was achieved in 8 patients. One patient underwent additional surgery because an adequate safe margin was not obtained by ESD.LimitationsOne endoscopist performed all procedures, and only 8 patients were studied in an uncontrolled manner.ConclusionsThe internal traction method appears to facilitate en bloc ESD of early gastric cancers larger than 20 mm.