Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video)

Gastrointest Endosc. 2011 Jan;73(1):163-7. doi: 10.1016/j.gie.2010.08.041. Epub 2010 Oct 27.


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.

Publication types

  • Clinical Trial
  • Video-Audio Media

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery*
  • Aged
  • Aged, 80 and over
  • Dental Devices, Home Care
  • Female
  • Gastric Mucosa / surgery*
  • Gastroscopy / methods*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery*
  • Surgical Instruments
  • Taiwan