Endoscopic submucosal dissection of gastric lesions using the “yo-yo technique”

We read with great interest the article by Baldaque-Silva F et al. [1], who evaluated the feasibility, efficacy, and safety of the “yo-yo technique” during gastric endoscopic submucosal dissection (ESD). This inexpensive technique can improve access to the lesion edges and the dissection plane, which is very helpful to endoscopists performing gastric ESD. Indeed, such papers, which aim to improve endoscopic techniques, are much welcomed.

Several aspects, in our opinion, are particularly important and of interest in this study. First, the technique of pushing and pulling the lesion edges to increase access to the submucosal space creates a blind area, which may preclude further operation. Secondly, the standard hemoclip and snare will easily cause tissue avulsion, which means that the integrity of the specimen cannot be assured. Moreover, the metal hemoclip and snare also conduct electricity, which may make resection difficult. Finally, the resections performed in the study may not be difficult for skilled endoscopists, which may enable the expansion of indications for this technique to large lesions or to other gastrointestinal regions such as the gastric fundus.

Although more endoscopic devices have been developed to make ESD easier and safer, skilled endoscopists still prefer a two-handed technique as in conventional surgery. Mochiki et al. devised a double endoscopic intraluminal operation and assessed its efficacy and safety for superficial gastric neoplasms [2]. Therefore, we think that it is still worth trying to make technical modifications and improvements to techniques, and therefore further and more wide-ranging research is required.

• References

• 1 Baldaque-Silva F, Vilas-Boas F, Velosa M et al. Endoscopic submucosal dissection of gastric lesions using the “yo-yo technique”. Endoscopy 2013; 45: 218-221
• 2 Mochiki E, Yanai M, Toyomasu Y et al. Clinical outcomes of double endoscopic intralumenal surgery for early gastric cancer. Surg Endosc 2010; 24: 631-636