Post written by Masafumi Kitamura, MD, from the Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan.

Gastric ESD using the PCM can be performed with a uniform strategy, regardless of the location of the lesion, and it is more straightforward for the operator than conventional methods. We here present 2 representative cases of gastric superficial lesions resected by ESD with the PCM.     

When the conventional method is used, the difficulty of gastric ESD is strongly influenced by the location. The greatest advantage of the PCM in gastric ESD is stabilization in the pocket at any location in the stomach. The PCM is a simple technique to achieve safe ESD, facilitating a tangential approach that enables retrieval of a specimen with a thick submucosal layer by selecting the dissection level. Gastric ESD using the PCM can be performed with a uniform strategy, regardless of the location of the lesion, and it is more straightforward for the operator than conventional methods. We believe that PCM is a universal strategy for gastric ESD.   

In gastric ESD with PCM, aspirating as much gas as possible from the gastric lumen is one of the most important tips for a successful procedure. Decreasing the size of the gastric lumen by aspirating gas can improve the maneuverability of the endoscope and facilitate a tangential approach. 

Although gastric ESD is widely performed at many institutions, endoscopists struggle to resect superficial gastric lesions at difficult locations. Gastric ESD using the PCM can be performed with a uniform strategy, regardless of the lesion’s location or the endoscopist’s experience.   

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