BACKGROUND: EMR 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. OBJECTIVE: To describe a simple technique of using internal traction to facilitate endoscopic submucosal dissection (ESD) procedures in the excision of large, early gastric cancers. DESIGN: Case series. SETTING: A tertiary medical center in Taiwan. PATIENTS AND METHODS: Eight patients with early gastric cancers larger than 20 mm underwent ESD. INTERVENTIONS: A standard hemoclip modified with surgical suture was used to provide traction to improve visualization of the dissection plane during ESD. MAIN OUTCOME MEASUREMENTS: Proportion with complete en bloc resection. RESULTS: En 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. LIMITATIONS: One endoscopist performed all procedures, and only 8 patients were studied in an uncontrolled manner. CONCLUSIONS: The internal traction method appears to facilitate en bloc ESD of early gastric cancers larger than 20 mm.
BACKGROUND: EMR 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. OBJECTIVE: To describe a simple technique of using internal traction to facilitate endoscopic submucosal dissection (ESD) procedures in the excision of large, early gastric cancers. DESIGN: Case series. SETTING: A tertiary medical center in Taiwan. PATIENTS AND METHODS: Eight patients with early gastric cancers larger than 20 mm underwent ESD. INTERVENTIONS: A standard hemoclip modified with surgical suture was used to provide traction to improve visualization of the dissection plane during ESD. MAIN OUTCOME MEASUREMENTS: Proportion with complete en bloc resection. RESULTS: En 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. LIMITATIONS: One endoscopist performed all procedures, and only 8 patients were studied in an uncontrolled manner. CONCLUSIONS: The internal traction method appears to facilitate en bloc ESD of early gastric cancers larger than 20 mm.
Authors: Anthony Yuen Bun Teoh; Philip Wai Yan Chiu; So Fei Hon; Tony Wing Chung Mak; Enders Kwok Wai Ng; James Yun Wong Lau Journal: Surg Endosc Date: 2012-10-24 Impact factor: 4.584