Endoscopic submucosal dissection of gastric lesions using the “yo-yo technique”

 

 Buy Article Permissions and Reprints

One of the main difficulties during endoscopic submucosal dissection (ESD) is the mobilization of the partially resected lesion in order to improve access to the lesion edges and the dissection plane. In the current study, the feasibility and safety of a new “yo-yo technique” to facilitate ESD procedures were evaluated. A total of 17 consecutive patients with gastric lesions were included. A standard hemoclip and snare were used to pull and push the lesion margins in order to increase the access to the lesion edges and to the submucosal space. All lesions were resected en bloc, without perforation or significant bleeding requiring blood transfusion, and all patients were discharged within 7 days. Resected specimens and lesions were 24 – 58 mm (mean 36 mm) and 18 – 45 mm (mean 25 mm) in size, respectively. The “yo-yo technique” is feasible, easy, and safe, and allows the lesion to be pulled and pushed during the ESD procedure. Further use of this technique may lead to the expansion of its indications to other gastrointestinal regions.

• References

• 1 Ahn JY, Jung HY, Choi KD et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc 2011; 74: 485-493
  CrossrefPubMedGoogle Scholar
• 2 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011; 14: 113-123
  CrossrefPubMedGoogle Scholar
• 3 Nonaka S, Oda I, Nakaya T et al. Clinical impact of a strategy involving endoscopic submucosal dissection for early gastric cancer: determining the optimal pathway. Gastric Cancer 2011; 14: 56-62
  CrossrefPubMedGoogle Scholar
• 4 Chen PJ, Chu HC, Chang WK et al. Endoscopic submucosal dissection with internal traction for early gastric cancer (with video). Gastrointest Endosc 2008; 67: 128-132
  CrossrefPubMedGoogle Scholar
• 5 Gotoda T, Oda I, Tamakawa K et al. Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest Endosc 2009; 69: 10-15
  CrossrefPubMedGoogle Scholar
• 6 Matsumoto K, Nagahara A, Sakamoto N et al. A new traction device for facilitating endoscopic submucosal dissection (ESD) for early gastric cancer: the “medical ring”. Endoscopy 2011; 43: 67-68
  Article in Thieme ConnectPubMedGoogle Scholar
• 7 Li CH, Chen PJ, Chu HC et al. Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). Gastrointest Endosc 2011; 73: 163-167
  CrossrefPubMedGoogle Scholar
• 8 Alfaro EE, Lauwers GY. Early gastric neoplasia: diagnosis and implications. Adv Anat Pathol 2011; 18: 268-280
  CrossrefPubMedGoogle Scholar
• 9 Kondo H, Gotoda T, Ono H et al. Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer. Gastrointest Endosc 2004; 59: 284-288
  CrossrefPubMedGoogle Scholar
• 10 Imaeda H, Iwao Y, Ogata H et al. A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps. Endoscopy 2006; 38: 1007-1010
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Jeon WJ, You IY, Chae HB et al. A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection. Gastrointest Endosc 2009; 69: 29-33
  CrossrefPubMedGoogle Scholar
• 12 Parra-Blanco A, Nicolas D, Arnau MR et al. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest Endosc 2011; 74: 1137-1141
  CrossrefPubMedGoogle Scholar
• 13 Murata A, Akahoshi K, Sumida Y et al. Prospective randomized trial of transnasal versus peroral endoscopy using an ultrathin videoendoscope in unsedated patients. J Gastroenterol Hepatol 2007; 22: 482-485
  CrossrefPubMedGoogle Scholar
• 14 Baskin WN. Acute complications associated with bedside placement of feeding tubes. Nutr Clin Pract 2006; 21: 40-55
  CrossrefPubMedGoogle Scholar
• 15 Sato R, Watari J, Tanabe H et al. Transnasal ultrathin endoscopy for placement of a long intestinal tube in patients with intestinal obstruction. Gastrointest Endosc 2008; 67: 953-957
  CrossrefPubMedGoogle Scholar
• 16 Boustiere C, Veitch A, Vanbiervliet G et al. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2011; 43: 445-461
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Farhat S, Chaussade S, Ponchon T et al. Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy 2011; 43: 664-670
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Probst A, Pommer B, Golger D et al. Endoscopic submucosal dissection in gastric neoplasia – experience from a European center. Endoscopy 2010; 42: 1037-1044
  Article in Thieme ConnectPubMedGoogle Scholar