Post written by Talia F. Malik, MD, from Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA.

In this study, we introduce a novel technique, “Endoscopic Mucosal Incisional, Closure, ResectiON (E-MICRON),” for safe and efficient en bloc resection of large gastric intramucosal lesions.

Endoscopic submucosal dissection is recommended for en bloc resection of these lesions. However, it is technically challenging and labor intensive, and reimbursement in the United States is rarely commensurate with the time required to perform the procedure. These limitations have hindered its widespread adoption outside tertiary referral centers. Compared with endoscopic submucosal dissection, E-MICRON is technically easier, less time-consuming, and likely carries a far lower risk of bleeding and perforation.

We describe 4 cases that highlight the application of this technique. In all cases, en bloc resection was achieved with negative deep and lateral margins.

E-MICRON allows for resection of a larger lesion than with a standard full-thickness resection device. The mucosal incision with E-MICRON permits a much deeper tissue area to be suctioned into the cap of the over-the-scope clip, enabling snare positioning just superficial to the muscularis propria and, if necessary, performance of transmural resection under direct visualization. In addition, E-MICRON overcomes several limitations of the over-the-scope resection device.

E-MICRON may facilitate more widespread use of endoscopic resection for neoplastic foregut lesions >2 cm in size and subepithelial tumors. Moreover, increased use of endoscopic resection could reduce morbidity related to surgery in select patients. Larger studies are necessary to corroborate our encouraging early results.

A, Circumferential endoscopic mucosal incision of the lesion is performed by using an endoscopic submucosal dissection knife. B, The lesion becomes considerably smaller once it is no longer tethered to the adjacent mucosa after circumferential endoscopic mucosal incision. C, Over-the-scope-clip (OTSC) is deployed after suctioning the lesion into the OTSC cap. D, Snare cautery resection is performed above the OTSC.

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