Endoscopic submucosal dissection with internal traction for early gastric cancer (with video)

Peng-Jen Chen, Heng-Cheng Chu, Wei-Kuo Chang, Tsai-Yuan Hsieh, You-Chen Chao

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


Background: EMR techniques have high success rates for treating small lesions of the upper-GI tract; however, tumors larger than 15 mm are frequently removed by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen. Objective: To describe a simple technique of using internal traction to facilitate endoscopic submucosal dissection (ESD) procedures in the excision of large, early gastric cancers. Design: Case series. Setting: A tertiary medical center in Taiwan. Patients and Methods: Eight patients with early gastric cancers larger than 20 mm underwent ESD. Interventions: A standard hemoclip modified with surgical suture was used to provide traction to improve visualization of the dissection plane during ESD. Main Outcome Measurements: Proportion with complete en bloc resection. Results: En bloc resection of the lesion was achieved in 8 patients. One patient underwent additional surgery because an adequate safe margin was not obtained by ESD. Limitations: One endoscopist performed all procedures, and only 8 patients were studied in an uncontrolled manner. Conclusions: The internal traction method appears to facilitate en bloc ESD of early gastric cancers larger than 20 mm. © 2008 American Society for Gastrointestinal Endoscopy.
Original languageEnglish
Pages (from-to)128-132
Number of pages5
JournalGastrointestinal Endoscopy
Issue number1
Publication statusPublished - 2008
Externally publishedYes


  • adult
  • aged
  • article
  • cancer patient
  • cancer surgery
  • clinical article
  • clip
  • controlled study
  • endoscopic surgery
  • female
  • gastrointestinal endoscopy
  • histopathology
  • human
  • male
  • priority journal
  • stomach cancer
  • suture
  • Taiwan
  • tertiary health care
  • tumor biopsy
  • Aged
  • Aged, 80 and over
  • Endoscopy, Gastrointestinal
  • Female
  • Humans
  • Male
  • Middle Aged
  • Stomach Neoplasms


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