Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video)

Chung-Hsien Li, Peng-Jen Chen, Heng-Cheng Chu, Tien-Yu Huang, Yu-Lueng Shih, Wei-Kuo Chang, Tsai-Yuan Hsieh

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: Using EMR techniques, physicians frequently remove tumors >15 mm by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen. Endoscopic submucosal dissection (ESD) of early-stage gastric cancer improves the rate of successful en bloc resection, but it is associated with more complications, such as bleeding and perforation, than conventional EMR. Objective To describe a simple technique that uses the pulley method to facilitate ESD procedures in the excision of large early-stage gastric cancers. Design Case series. Setting Tertiary medical center in Taiwan. Patients and Methods Eleven patients with early-stage gastric cancers or adenomas >20 mm underwent ESD. Interventions The pulley method with standard clips and dental floss was used to provide traction to improve visualization of the dissection plane during ESD. Main Outcome Measurement Proportion with complete en bloc resection. Results En bloc resection of the lesion was achieved in 11 patients. No perforation or emergent surgery was noted. Limitations One endoscopist performed all procedures, and only 11 patients were studied in an uncontrolled manner. Conclusions The pulley method seems to facilitate en bloc ESD of early-stage gastric cancers >20 mm. © 2011 American Society for Gastrointestinal Endoscopy.
Original languageEnglish
Pages (from-to)163-167
Number of pages5
JournalGastrointestinal Endoscopy
Volume73
Issue number1
DOIs
Publication statusPublished - 2011
Externally publishedYes

Fingerprint

Stomach Neoplasms
Home Care Dental Devices
Gastrointestinal Endoscopy
Traction
Taiwan
Surgical Instruments
Adenoma
Endoscopic Mucosal Resection
Dissection
Hemorrhage
Physicians
Recurrence
Neoplasms

Keywords

  • adult
  • aged
  • article
  • cancer patient
  • cancer size
  • cancer staging
  • clinical article
  • early cancer
  • endoscopic submucosal dissection
  • female
  • human
  • male
  • priority journal
  • stomach cancer
  • stomach hemorrhage
  • stomach perforation
  • surgical technique
  • treatment outcome
  • Adenocarcinoma
  • Aged
  • Aged, 80 and over
  • Dental Devices, Home Care
  • Female
  • Gastric Mucosa
  • Gastroscopy
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Stomach Neoplasms
  • Surgical Instruments
  • Taiwan

Cite this

Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). / Li, Chung-Hsien; Chen, Peng-Jen; Chu, Heng-Cheng; Huang, Tien-Yu; Shih, Yu-Lueng; Chang, Wei-Kuo; Hsieh, Tsai-Yuan.

In: Gastrointestinal Endoscopy, Vol. 73, No. 1, 2011, p. 163-167.

Research output: Contribution to journalArticle

Li, Chung-Hsien ; Chen, Peng-Jen ; Chu, Heng-Cheng ; Huang, Tien-Yu ; Shih, Yu-Lueng ; Chang, Wei-Kuo ; Hsieh, Tsai-Yuan. / Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). In: Gastrointestinal Endoscopy. 2011 ; Vol. 73, No. 1. pp. 163-167.
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abstract = "Background: Using EMR techniques, physicians frequently remove tumors >15 mm by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen. Endoscopic submucosal dissection (ESD) of early-stage gastric cancer improves the rate of successful en bloc resection, but it is associated with more complications, such as bleeding and perforation, than conventional EMR. Objective To describe a simple technique that uses the pulley method to facilitate ESD procedures in the excision of large early-stage gastric cancers. Design Case series. Setting Tertiary medical center in Taiwan. Patients and Methods Eleven patients with early-stage gastric cancers or adenomas >20 mm underwent ESD. Interventions The pulley method with standard clips and dental floss was used to provide traction to improve visualization of the dissection plane during ESD. Main Outcome Measurement Proportion with complete en bloc resection. Results En bloc resection of the lesion was achieved in 11 patients. No perforation or emergent surgery was noted. Limitations One endoscopist performed all procedures, and only 11 patients were studied in an uncontrolled manner. Conclusions The pulley method seems to facilitate en bloc ESD of early-stage gastric cancers >20 mm. {\circledC} 2011 American Society for Gastrointestinal Endoscopy.",
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author = "Chung-Hsien Li and Peng-Jen Chen and Heng-Cheng Chu and Tien-Yu Huang and Yu-Lueng Shih and Wei-Kuo Chang and Tsai-Yuan Hsieh",
note = "被引用次數:26 Export Date: 22 March 2016 CODEN: GAENB 通訊地址: Chen, P.-J.; Division of Gastroenterology, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Road, Neihu District, Taipei City 114, Taiwan 參考文獻: Soetikno, R., Gotoda, T., Nakanishi, Y., Endoscopic mucosal resection (2003) Gastrointest Endosc, 57, pp. 567-579; Tanabe, S., Koizumi, W., Mitomi, H., Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer (2002) Gastrointest Endosc, 56, pp. 708-713; Gotoda, T., Endoscopic diagnosis and treatment for early gastric cancer (2004) Cancer Rev Asia Pac, 2, pp. 17-37; Chen, P.J., Chu, H.C., Chang, W.K., Endoscopic submucosal dissection with internal traction for early gastric cancer (2008) Gastrointest Endosc, 67, pp. 128-132; Kondo, H., Gotoda, T., Ono, H., Percutaneous tractionassisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer (2004) Gastrointest Endosc, 59, pp. 284-288; Gotoda, T., Oda, I., Tamakawa, K., Prospective clinical trial of magnetic-anchorguided endoscopic submucosal dissection for large early gastric cancer (2009) Gastrointest Endosc, 69, pp. 10-15; Imaeda, H., Iwao, Y., Ogata, H., A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps (2006) Endoscopy, 38, pp. 1007-1010; Jeon, W.J., You, I.Y., Chae, H.B., A new technique for gastric endoscopic submucosal dissection: Peroral traction-assisted endoscopic submucosal dissection (2009) Gastrointest Endosc, 69, pp. 29-33; Onozato, Y., Ishihara, H., Iizuka, H., Endoscopic submucosal dissection for early gastric cancers and large flat adenomas (2006) Endoscopy, 38, pp. 980-986; Lee, I.L., Lin, P.Y., Tung, S.Y., Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer (2006) Endoscopy, 38, pp. 1024-1028; Chen, P.J., Hsieh, T.Y., Chao, Y.C., Clinical challenges and images in GI (2007) Gastroenterology, 132, p. 853; Yamamoto, H., Kawata, H., Sunada, K., Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood (2003) Endoscopy, 35, pp. 690-694; Yonezawa, J., Kaise, M., Sumiyama, K., A novel double-channel therapeutic endoscope ({"}R-scope{"}) facilitates endoscopic submucosal dissection of superficial gastric neoplasms (2006) Endoscopy, 38, pp. 1011-1015; Neuhaus, H., Costamagna, G., Devire, J., Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the {"}r-scope{"}) (2006) Endoscopy, 38, pp. 1016-1023",
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TY - JOUR

T1 - Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video)

AU - Li, Chung-Hsien

AU - Chen, Peng-Jen

AU - Chu, Heng-Cheng

AU - Huang, Tien-Yu

AU - Shih, Yu-Lueng

AU - Chang, Wei-Kuo

AU - Hsieh, Tsai-Yuan

N1 - 被引用次數:26 Export Date: 22 March 2016 CODEN: GAENB 通訊地址: Chen, P.-J.; Division of Gastroenterology, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Road, Neihu District, Taipei City 114, Taiwan 參考文獻: Soetikno, R., Gotoda, T., Nakanishi, Y., Endoscopic mucosal resection (2003) Gastrointest Endosc, 57, pp. 567-579; Tanabe, S., Koizumi, W., Mitomi, H., Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer (2002) Gastrointest Endosc, 56, pp. 708-713; Gotoda, T., Endoscopic diagnosis and treatment for early gastric cancer (2004) Cancer Rev Asia Pac, 2, pp. 17-37; Chen, P.J., Chu, H.C., Chang, W.K., Endoscopic submucosal dissection with internal traction for early gastric cancer (2008) Gastrointest Endosc, 67, pp. 128-132; Kondo, H., Gotoda, T., Ono, H., Percutaneous tractionassisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer (2004) Gastrointest Endosc, 59, pp. 284-288; Gotoda, T., Oda, I., Tamakawa, K., Prospective clinical trial of magnetic-anchorguided endoscopic submucosal dissection for large early gastric cancer (2009) Gastrointest Endosc, 69, pp. 10-15; Imaeda, H., Iwao, Y., Ogata, H., A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps (2006) Endoscopy, 38, pp. 1007-1010; Jeon, W.J., You, I.Y., Chae, H.B., A new technique for gastric endoscopic submucosal dissection: Peroral traction-assisted endoscopic submucosal dissection (2009) Gastrointest Endosc, 69, pp. 29-33; Onozato, Y., Ishihara, H., Iizuka, H., Endoscopic submucosal dissection for early gastric cancers and large flat adenomas (2006) Endoscopy, 38, pp. 980-986; Lee, I.L., Lin, P.Y., Tung, S.Y., Endoscopic submucosal dissection for the treatment of intraluminal gastric subepithelial tumors originating from the muscularis propria layer (2006) Endoscopy, 38, pp. 1024-1028; Chen, P.J., Hsieh, T.Y., Chao, Y.C., Clinical challenges and images in GI (2007) Gastroenterology, 132, p. 853; Yamamoto, H., Kawata, H., Sunada, K., Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood (2003) Endoscopy, 35, pp. 690-694; Yonezawa, J., Kaise, M., Sumiyama, K., A novel double-channel therapeutic endoscope ("R-scope") facilitates endoscopic submucosal dissection of superficial gastric neoplasms (2006) Endoscopy, 38, pp. 1011-1015; Neuhaus, H., Costamagna, G., Devire, J., Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the "r-scope") (2006) Endoscopy, 38, pp. 1016-1023

PY - 2011

Y1 - 2011

N2 - Background: Using EMR techniques, physicians frequently remove tumors >15 mm by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen. Endoscopic submucosal dissection (ESD) of early-stage gastric cancer improves the rate of successful en bloc resection, but it is associated with more complications, such as bleeding and perforation, than conventional EMR. Objective To describe a simple technique that uses the pulley method to facilitate ESD procedures in the excision of large early-stage gastric cancers. Design Case series. Setting Tertiary medical center in Taiwan. Patients and Methods Eleven patients with early-stage gastric cancers or adenomas >20 mm underwent ESD. Interventions The pulley method with standard clips and dental floss was used to provide traction to improve visualization of the dissection plane during ESD. Main Outcome Measurement Proportion with complete en bloc resection. Results En bloc resection of the lesion was achieved in 11 patients. No perforation or emergent surgery was noted. Limitations One endoscopist performed all procedures, and only 11 patients were studied in an uncontrolled manner. Conclusions The pulley method seems to facilitate en bloc ESD of early-stage gastric cancers >20 mm. © 2011 American Society for Gastrointestinal Endoscopy.

AB - Background: Using EMR techniques, physicians frequently remove tumors >15 mm by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen. Endoscopic submucosal dissection (ESD) of early-stage gastric cancer improves the rate of successful en bloc resection, but it is associated with more complications, such as bleeding and perforation, than conventional EMR. Objective To describe a simple technique that uses the pulley method to facilitate ESD procedures in the excision of large early-stage gastric cancers. Design Case series. Setting Tertiary medical center in Taiwan. Patients and Methods Eleven patients with early-stage gastric cancers or adenomas >20 mm underwent ESD. Interventions The pulley method with standard clips and dental floss was used to provide traction to improve visualization of the dissection plane during ESD. Main Outcome Measurement Proportion with complete en bloc resection. Results En bloc resection of the lesion was achieved in 11 patients. No perforation or emergent surgery was noted. Limitations One endoscopist performed all procedures, and only 11 patients were studied in an uncontrolled manner. Conclusions The pulley method seems to facilitate en bloc ESD of early-stage gastric cancers >20 mm. © 2011 American Society for Gastrointestinal Endoscopy.

KW - adult

KW - aged

KW - article

KW - cancer patient

KW - cancer size

KW - cancer staging

KW - clinical article

KW - early cancer

KW - endoscopic submucosal dissection

KW - female

KW - human

KW - male

KW - priority journal

KW - stomach cancer

KW - stomach hemorrhage

KW - stomach perforation

KW - surgical technique

KW - treatment outcome

KW - Adenocarcinoma

KW - Aged

KW - Aged, 80 and over

KW - Dental Devices, Home Care

KW - Female

KW - Gastric Mucosa

KW - Gastroscopy

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasm Staging

KW - Stomach Neoplasms

KW - Surgical Instruments

KW - Taiwan

U2 - 10.1016/j.gie.2010.08.041

DO - 10.1016/j.gie.2010.08.041

M3 - Article

VL - 73

SP - 163

EP - 167

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 1

ER -