CC BY 4.0 · Endoscopy 2024; 56(S 01): E301-E302
DOI: 10.1055/a-2286-5543
E-Videos

Endoscopic submucosal dissection for residual gastric lesion made easier thanks to use of adaptative traction device

Elena De Cristofaro
1   Gastroenterology Unit, University of Rome Tor Vergata, Rome, Italy (Ringgold ID: RIN9318)
,
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Jérôme Rivory
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Jean Grimaldi
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Louis Jean Masgnaux
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Alexandru Lupu
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Mathieu Pioche
2   Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
› Author Affiliations

European guidelines recommend endoscopic submucosal dissection (ESD) for gastric dysplastic lesions to ensure en bloc resection and for a lower risk of recurrence than endoscopic mucosal resection (EMR) [1]. However, this procedure is considered technically challenging especially for residual lesions in which the fibrosis after previous treatments can be found in the submucosal space and EMR is still performed with a local risk of recurrence. Herein, we report the case of a 66-year-old woman assessed for ESD of a residual dysplastic gastric lesion at the site of previous piecemeal EMR resection (posterior wall of antrum) ([Video 1]).


Quality:
Adaptive traction device makes endoscopic submucosal dissection for residual gastric lesion easier.Video 1

Several techniques, such as traction strategies, have already been described to facilitate these technically challenging procedures. In previous cases we reported the benefits of using a new adaptative multipolar traction system (A-TRACT) in different challenging resections. This device facilitates the dissection phase through exposing the submucosa and accelerating the procedure [2] [3] [4] [5].

After circumferential incision with large margins and submucosal trimming, an adaptative traction device (A-TRACT 2) was used to improve submucosal exposure ([Fig. 1]). The two loops were fixed by clips at the edges of the lesion. The rubber band was fixed to the opposite wall to achieve 90° of traction and the dissection was started with traction. The device was tightened when exposure was poor, and the procedure was completed after 35 minutes with good submucosal exposure and no adverse events. Resection was R0 and the histopathology revealed an adenoma with low-grade dysplasia.

Zoom Image
Fig. 1 Schematic view after piecemeal endoscopic mucosal resection (EMR). a EMR recurrence. b Traction device setup. c Dissection under traction. d Device tightening to improve traction.

We can assume that this adaptative traction device can make ESD procedures feasible and faster, especially in selected cases like residual lesions, allowing curative endoscopic treatment.

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Publication History

Article published online:
03 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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