Easier removal of a gastrointestinal stromal tumor using a new detachable snare-assisted traction technique

A 51-year-old woman presented to our department with a stromal tumor (about 3 × 2 cm) in the gastric body ([Fig. 1]). After the tumor had been marked, mucosal and submucosal incision was commenced, but it was not possible to make an effective incision owing to the narrow gap between the tumor and the normal muscularis propria caused by the effect of gravity on the tumor ([Video 1]). A detachable snare was used to trap part of the tumor and a clip with a traction wire was used to clamp the detached snare to create traction. After traction had been applied via the detached snare, the incision gap was enlarged ([Fig. 2]) and the tumor was then rapidly excised by the now effective incision ([Fig. 3]). Pathologic examination showed that the tumor was a low risk gastrointestinal stromal tumor of 3 × 2 cm. Follow-up after 1 month showed that the wound had healed ([Fig. 4]).

Fig. 1 Computed tomography image showing a stromal tumor (about 3 × 2 cm) in the upper gastric body.

Video 1 Easier removal of a gastrointestinal tumor is shown using a new detachable snare-assisted traction technique.

Fig. 2 Endoscopic image showing the enlarged incision gap after traction had been applied via the detached snare.

Fig. 3 Macroscopic appearance of the resected tumor specimen.

Fig. 4 Follow-up endoscopy after 1 month showing the healed wound.

Traction techniques have effectively shortened the procedure time, and can help to avoid unnecessary bleeding and perforation during endoscopic submucosal dissection [1] [2]. A clip with a traction wire has often been used to enlarge the incision gap [3]. For large tumors, snares are a useful traction method [4]; however, the snare is hard to release when it has trapped the tumor. Therefore, we designed a detachable snare to trap the tumor and create traction that is then easier to release. This is first report of the use of the detachable snare to create effective traction to remove a tumor.

Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB

Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Abe S, Wu SYS, Ego M. et al. Efficacy of current traction technique for endoscopic submucosal dissection. Gut Liver 2020; 14: 673-684
• 2 Lambin T, Rivory J, Wallenhorst T. et al. Endoscopic submucosal dissection: how to be more efficient?. Endosc Int Open 2021; 9: E1720-E1730
• 3 Liu XG, Chen ZY, Yang YC. et al. Combined preclosure technique and traction method facilitating endoscopic full-thickness resection of a gastric fundal gastrointestinal stromal tumor. Endoscopy 2020; 52: E293-E294
• 4 Chou CK, Chen CC, Chen SS. et al. Snare traction and endoscopic suturing can improve endoscopic management of gastrointestinal stromal tumors at the gastric greater curvature. Endoscopy 2023; 55: E216-E217

Publication History

Article published online:
13 July 2023