An innovative technique for endoscopic submucosal dissection of early gastric cancer using a new spring device

Abstract

Using the aforementioned indices, we evaluated the performance speed of ESD. Spring-assisted ESD may allow faster submucosal dissection.

Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video)

“…9 To facilitate the dissection, several methods have been proposed for use in the stomach and the colon: using longer-lasting solutions in the submucosa, 10 transparent hoods, 10 or traction methods. [12][13][14][15][16][17][18][19][20][21][22] The method proposed by Sakurazawa et al 21 has some similarities to ours. However, in their study, the second clip was applied not distally to the lesion, but on the opposite gastric wall.…”

Development and clinical usability of a new traction device “medical ring” for endoscopic submucosal dissection of early gastric cancer

“…Traction systems that facilitate ESD, such as PTA-EMR [8], the magnetic anchor system [9], external grasping forceps [10], peroral traction-assisted ESD [11], spring devices [12], clip-band technique [13], etc., have been described, although each has its own unique limitations. PTA-EMR, which requires a laparoscopic port with a trocar, is very invasive and expensive and necessitates use of an operating room and anesthesia [8].…”

“…When traction is applied, not only should the submucosal layer be visually recognized, but the scope should be at a suitable distance so that the cleaving direction also is intelligible. Various methods used to pull up the submucosal layer to facilitate visibility have been reported [7–12]. However, a device for this purpose that is not invasive and is convenient, cost effective, sanitary, and safe has not been developed.…”

Endoscopic submucosal dissection

“…As such, several methods and devices have been evaluated for improved tissue retraction during ESD, including weighted ("sinker") clips that augment gravity retraction, clip(s) with thread external and internal traction methods, external grasping forceps, magnetic anchor retraction systems, spring devices, and dualendoscope methods. [4][5][6] None of these methods have gained widespread adoption, and enhanced tissue retraction remains a targeted area for investigation at this time.…”