Post written by Takashi Muramoto, MD, PhD, from the Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan.

The video describes the usefulness of a thin-endoscope endoscopic submucosal dissection (ESD) using the traction device for early gastric cancer in a patient with an esophageal stricture. A 72-year-old man was referred to our hospital for treatment of early gastric cancer measuring 25 mm in diameter located in the lesser curvature of the middle gastric body. However, since a conventional endoscope couldn’t approach because of the esophageal stricture caused by the displacement of a vertebral body, thin-endoscope ESD was scheduled.

The entire procedure for thin-endoscope ESD is shown in the video. We used EG-L580NW7 (Fujifilm, Tokyo, Japan) as a thin-endoscope, which has a relatively smaller scope diameter of 5.8 mm and working channel diameter of 2.4 mm. Moreover, SOUTEN (Kaneka Medics, Tokyo, Japan) was used as the cutting device. Marking, mucosal incision, and submucosal dissection were all performed using a 1.5-mm needle knife with a knob-shaped tip of SOUTEN. Although it was difficult to dissect submucosa gradually due to the vertical approach, a good field of view was established for dissection by applying a traction device made of dental floss and endoclip. Finally, the lesion was completely resected en-bloc in 45 minutes without any adverse events.

Previously, endoscopic resection could be performed only after dilatation for the stricture, such as a balloon, but this entails the risk of adverse events (eg, perforation and bleeding). Thin-endoscope ESD that does not require dilatation can be one of the treatment options for early gastric cancer where the conventional endoscope cannot be utilized for any reason, such as the presence of an esophageal stricture.

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