Post written by Yohei Koyama, MD, from the Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan.

Situs inversus totalis (SIT) is defined as the complete mirror-image transposition of the thoracic and abdominal viscera. It is a relatively rare congenital anomaly with an incidence of approximately 1 per 4,000 to 8,000 persons. Endoscopic submucosal dissection (ESD) is widely performed as a treatment for early gastric cancer. The strategy uses the effective countertraction produced by gravity, which enables dissections to be performed quickly and safely.

To the best of our knowledge, this is the first video case of ESD of early gastric cancer in a patient with SIT. Our video shows tips for ESD for SIT patients. A clear endoscopic view and good countertraction is important to perform ESD. However, we could not obtain this in patients with SIT due to the inverted position of the stomach in the conventional left decubitus position.

ESD in the right lateral decubitus position for patients with SIT is a simple and effective method that does not require other traction devices. We hope our video will help doctors who perform ESD for SIT patients in the future.

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