Background: Using EMR techniques, physicians frequently remove tumors >15 mm by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen. Endoscopic submucosal dissection (ESD) of early-stage gastric cancer improves the rate of successful en bloc resection, but it is associated with more complications, such as bleeding and perforation, than conventional EMR.
Objective: To describe a simple technique that uses the pulley method to facilitate ESD procedures in the excision of large early-stage gastric cancers.
Design: Case series.
Setting: Tertiary medical center in Taiwan.
Patients and methods: Eleven patients with early-stage gastric cancers or adenomas >20 mm underwent ESD.
Interventions: The pulley method with standard clips and dental floss was used to provide traction to improve visualization of the dissection plane during ESD.
Main outcome measurement: Proportion with complete en bloc resection.
Results: En bloc resection of the lesion was achieved in 11 patients. No perforation or emergent surgery was noted.
Limitations: One endoscopist performed all procedures, and only 11 patients were studied in an uncontrolled manner.
Conclusions: The pulley method seems to facilitate en bloc ESD of early-stage gastric cancers >20 mm.
Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.