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

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.