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 ).
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.
Endoscopy_UCTN_Code_TTT_1AO_2AG
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