Retroflexed endoscopic full-thickness resection

Xuefeng Lu, MD, from Qilu Hospital, Shandong University School of Medicine, in Jinan, China discusses this New Methods article “Facilitating retroflexed endoscopic full-thickness resection through loop-mediated or rope-mediated countertraction (with videos).”

Our study focused on providing simple and effective methods to provide counter-traction during endoscopic resection of gastric submucosal tumors.

Compared to laparoscopic surgery, endoscopic resection is a less invasive approach to manage small (<3cm) gastric submucosal tumors. A common technical hurdle during endoscopic resection, however, is poor visualization and maneuverability. We demonstrated here that by utilizing surgical suture or a snare, effective counter-traction can be achieved and the procedure could be much simplified.

C, A hemoclip tied with a silk suture was anchored at the distal edge of the submucosal tumor to aid in exposure, hence the resection could be performed in a limited, mucosa-covering incision. D, Exposure and dissection of the submucosal tumor base with the aid of the snare.

We found the mean operative time was significantly reduced by both methods from around one and a half hours to 40 minutes; the method using the snare was more maneuverable in terms of providing retraction, but takes more time to master. Outcomes of surgery were not jeopardized by these methods, as expected. Future studies may focus on modifications on the current methods and training of endoscopic  resection techniques.

Endoscopic resection can be sophisticated, with an awesome array of instrumentation; it can also be simple, with a combination of what we have got. When we face a huge gap, we build a bridge; we it is a small one, we jump further; it is all about cost-effectiveness.

Read the abstract for this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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