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Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video)
Chung-Hsien Li1, Peng-Jen Chen, Heng-Cheng Chu
1Division of Gastroenterology, Tri-Service General Hospital, Taipei, Taiwan.
Background:
Using EMR techniques, physicians frequently remove tumors >15 mm by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen. Endoscopic submucosal dissection (ESD) of early-stage gastric cancer improves the rate of successful en bloc resection, but it is associated with more complications, such as bleeding and perforation, than conventional EMR.
Objective:
To describe a simple technique that uses the pulley method to facilitate ESD procedures in the excision of large early-stage gastric cancers.
Design:
Case series.
Setting:
Tertiary medical center in Taiwan.
Patients And Methods:
Eleven patients with early-stage gastric cancers or adenomas >20 mm underwent ESD.
Interventions:
The pulley method with standard clips and dental floss was used to provide traction to improve visualization of the dissection plane during ESD.
Main Outcome Measurement:
Proportion with complete en bloc resection.
Results:
En bloc resection of the lesion was achieved in 11 patients. No perforation or emergent surgery was noted.
Limitations:
One endoscopist performed all procedures, and only 11 patients were studied in an uncontrolled manner.
Conclusions:
The pulley method seems to facilitate en bloc ESD of early-stage gastric cancers >20 mm.