Post written by Yusuke Fujiyoshi, MD, from the Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
This video shows an endoscopic submucosal dissection of a 25-mm 0-IIa+Is lesion in the gastric cardia. A newly developed super-soft hood (Space Adjuster, TOP Corp, Tokyo, Japan) was used as a distal attachment of the endoscope. A multipoint traction technique was used during the procedure.
A super-soft hood made of silicon was used as a distal attachment, which has the capability of entering easily and adjusting its tip to the shape of narrow spaces (esophageal lumen, submucosal layer, etc) due to its increased flexibility. With the multipoint traction technique, a snare is secured along the edge of the specimen with endoclips at multiple points. By pulling the snare, a tension on the specimen is made. We also apply additional maneuvers such as pushing the snare and closing the snare around the clips. These techniques create further tension, thus making dissection easier. By combining the super-soft hood and multipoint traction technique, this hood fits into the submucosal space created by the multipoint traction technique. This combination aids in an easier ESD.
ESD for lesions in the cardia can be technically challenging because of the difficulty of getting close to the lesion and entering the submucosal space in retroflexion. By using these tools and techniques, this can be possible in forward view. Combining the super-soft hood with the multipoint traction technique obtained ideal countertraction. While ESD may be technically challenging, the 2 aforementioned methods improve efficiency and safety.
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