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CC BY 4.0 · Endoscopy 2024; 56(S 01): E346-E347
DOI: 10.1055/a-2291-9183
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Internal and external bidirectional traction facilitating endoscopic submucosal excavation of a huge subepithelial tumor in the fornix of the gastric fundus near the cardia

Authors

  • Zhi-qiang Du

    1   Department of Gastroenterology, The Peopleʼs Hospital of Jianyang City, Jianyang, China (Ringgold ID: RIN546231)

  • Jing Tang 

    2   Department of Gastroenterology, Guangyuan Central Hospital, Guangyuan, China (Ringgold ID: RIN159414)

  • Wei-hui Liu 

    3   Department of Gastroenterology and Hepatology, Sichuan Provincial Peopleʼs Hospital, School of Medicine, Chengdu, China
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Endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFTR) are efficacious and reliable methods for managing gastrointestinal subepithelial tumors [1] [2] [3]. Some traction methods are often used to expose subepithelial tumors [3]. However, traditional traction methods may be inadequate for full exposure and complete excavation [4] [5]. To address this issue, we have developed an internal and external bidirectional traction method that has been successfully utilized in ESE ([Video 1]).

Endoscopic submucosal excavation of a huge subepithelial tumor in the fornix of the gastric fundus near the cardia using internal and external bidirectional traction.Video 1

A 40-year-old man with a huge subepithelial tumor located in the fornix of the gastric fundus near the cardia was referred for ESE treatment ([Fig. 1] a). Due to the specific location and the limited angle of the endoscope, it was difficult to get close to the tumor. First, a clip with a rubber band was attached to the mucosa on the anal side of the tumor. Then the second clip picked up the rubber band and fixed it to the greater curvature mucosa opposite the gastric fundus ([Fig. 1] b). After transverse incision of the mucosa, the tumor was clearly exposed ([Fig. 1] c). We dissected the outer edge of the tumor and found that it was difficult to expose the boundary. The third clip with dental floss was fixed on the oral side of the incised mucosa ([Fig. 1] d). By pulling the dental floss and using air control, the boundary of the tumor was clearly exposed. Under lifting force of the internal and external bidirectional traction, the tumor was excavated quickly and completely ([Fig. 1] e). Since the surgical wound was well presented using this traction method, we performed sufficient hemostasis on the entire wound ([Fig. 1] f).

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Fig. 1 Schematic picture of the internal and external bidirectional traction method for endoscopic submucosal excavation of a huge subepithelial tumor in the fornix of gastric fundus near the cardia. a A subepithelial tumor measuring about 5.0 × 3.0 cm in the fornix of gastric fundus near the cardia. b A clip with a rubber band was attached to the mucosa on the anal side of the lesion and the second clip picked up the rubber band and was fixed on the mucosa of the greater curvature opposite to the gastric fundus. c Transverse incision of the mucosa in the middle of the tumor and clear exposure of the tumor under internal traction. d The third clip with dental floss was fixed on the oral side of the incised mucosa. e The tumor was dissected with the complete capsule. f Sufficient hemostasis on the surgical wound was performed with the help of internal and external bidirectional traction.

This method helps to expose the tumor quickly during incision of the mucosa, meanwhile ensuring dissection of the tumor with the complete capsule. It does not require special instruments and may be a suitable method for the ESE and EFTR in some special sites.

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Publication History

Article published online:
11 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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