Post written by Chung-Ying Lee, MD, from the Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

We present a video showcasing a novel double endoscope—assisted snare traction method designed to facilitate safe and efficient endoscopic full-thickness resection (EFTR) for a 30-mm exophytic gastric subepithelial lesion (SEL). The video provides a detailed description of this technique.

EFTR has been increasingly performed for intraluminal SELs originating from the muscularis propria with advancements in endoscopic techniques. However, EFTR for exophytic SELs remains technically challenging because of the higher risks of uncontrolled bleeding and potential damage to adjacent organs during dissection of the outer margin.

Therefore, by using the double endoscope—assisted snare traction method, the application of EFTR for exophytic gastric SELs may be expanded.

This method offers several advantages. First, we used an adjustable snare through an additional endoscope to capture part of the tumor, enabling us to apply real-time multidirectional traction force by pushing or pulling the snare. By pulling the tumor into the gastric lumen, we can precisely explore the outer margin and maintain the dissection process intraluminally, minimizing the risk of damaging the serosal vessels and reducing the area of the gastric wall defect.

In addition, after complete tumor resection, snare traction can prevent the tumor from dislodging into the peritoneum.

Overall, this method provides a level of safety and efficiency in assisting EFTR for gastric exophytic SELs that is comparable to that of intraluminal SELs.

One 30-mm exophytic-type subepithelial lesion at greater curvature of gastric body.

Read the full article online.

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