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, 4 (12), 558-560
eCollection

A Challenging Case of Gastric Endoscopic Submucosal Dissection: Removal of a Sizable Cancer Through Altering Patient's Position and Multiple Clip-Line Traction

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A Challenging Case of Gastric Endoscopic Submucosal Dissection: Removal of a Sizable Cancer Through Altering Patient's Position and Multiple Clip-Line Traction

Seiichiro Abe et al. VideoGIE.

Abstract

No abstract available

Keywords: ESD, endoscopic submucosal dissection.

Figures

Figure 1
Figure 1
Identification of a large elevated lesion in the greater curvature of the upper gastric body, although visualization of the entire lesion is difficult because of puddle formation with the patient in the left lateral position.
Figure 2
Figure 2
A change in patient’s position from left to right lateral allows much better visualization of the lesion by shifting the puddle to the cardia using gravity. Marking around the lesion has been performed.
Figure 3
Figure 3
Endoscopic submucosal dissection strategy before multiple clip line traction. 1, Mucosal incision of the distal side with dual knife. 2, Submucosal dissection of the distal side with dual knife (KD-650U; Olympus Medical Systems Corp, Tokyo, Japan). 3, Circumferential mucosal incision completed with IT 2 knife (KD-612U; Olympus Medical Systems Corp. Tokyo, Japan).
Figure 4
Figure 4
Completion of circumferential mucosal incision.
Figure 5
Figure 5
Addition of clip-line traction to the left side of the lesion to expose the submucosa, making dissecting much more efficient.
Figure 6
Figure 6
Patient’s position and multiple clip-line traction allow satisfactory tissue traction to be maintained until the end of the procedure.
Figure 7
Figure 7
Achievement of en bloc resection.
Figure 8
Figure 8
Closure of the large mucosal defect with 3 endoloops and endoclips, and complete closure of the defect.
Figure 9
Figure 9
Resected specimen (118 mm × 99 mm), revealing well-differentiated tubular adenocarcinoma, with deepest invasion confined to the mucosa, no evidence of ulceration, and negative margins, with the cancer measuring up to 86 mm × 70 mm.

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References

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