Application of blunt dissection in ESD of a gastric submucosal tumor

Abstract

We performed endoscopic submucosal dissection of a gastric fundus tumor. It was difficult to strip the tumor completely due to space limitation, and we used blunt dissection to remove the tumor quickly and safely. Firstly, the basal area of the 2.5 cm submucosal tumor located in the gastric fundus was cut open, and the mucosa was dissected. The tumor was difficult to peel, therefore, a snare was used and the tumor was pulled and tightened slightly. Short electronic coagulation was used during the procedure. The tumor was then bluntly dissected. This method ensured rapid and complete removal of the tumor.

A Novel Technique for Endoscope Progression in Gastroscopy Resection: “6”- Turn of Gastroscopy Along The Greater Curvature Wall for Dissection of Stromal Tumor in The Muscularis Propria of The Gastric Fundus

“…The fundus of the stomach is considered a challenging area for ESD [17], ESE, or EFTR [18,19]; the ESD technique is complex and prone to perforation [27], and the EFTR technique intentionally destroys the full thickness of the gastric wall, causing perforation to remove the lesion then sutures the wound by nylon suture and or hemostatic clips [28]. One of the current endoscopic treatments used for STMF is EFTR [16].…”

“…Endoscopic operation on gastric fundus is challenging, mainly due to the need for the traditional endoscopic progression method to be bent backward (U-turn) to access and observe the fundus of the stomach completely. The direction of endoscopy body movement is opposite to the direction of observation (paradoxical movement), and the endoscopy body gets suspended, which makes the operating space for the fundus of the stomach limited [17]. When the endoscope's body is suspended using the common U-turn technique, the forward injection force becomes immensely impaired, and the injection needle is perpendicular to the muscularis propria, making it di cult to nd the submucosal space.…”

“…Several gastroscopy dissection techniques are used nowadays in clinical practice, including Endoscopic submucosal dissection (ESD) [7], endoscopic submucosal excavation (ESE) [8], endoscopic full-thickness resection (EFTR) [9,10], submucosal tunneling endoscopic resection (STER) [11], and the combination of EFTR and laparoscopic approach [3,[12][13][14][15]. The fundus of the stomach is considered a challenging area for endoscopic resection of tumors in muscularis propria [16], especially when using ESD [17], ESE, or EFTR [18,19]. Additionally, endoscopic resection of lesions in the middle of the fornix and the anterior wall of the fornix is extremely di cult in clinical practice, especially the anterior wall of the fornix at the side of the greater curvature.…”

A novel technique for endoscope progression in gastroscopy resection: “6”- turn of gastroscopy along the greater curvature wall for dissection of stromal tumor in the muscularis propria of the gastric fundus

“…The fundus of the stomach is considered a challenging area for ESD 17 , ESE, or EFTR 18,19 ; the ESD technique is complex and prone to perforation 21 , and the EFTR technique intentionally destroys the full thickness of the gastric wall, causing perforation to remove the lesion then sutures the wound by nylon suture and or hemostatic clips 22 . One of the current endoscopic treatments used for STMF is EFTR 16 .…”

“…Several gastroscopy dissection techniques are used nowadays in clinical practice, including Endoscopic submucosal dissection (ESD) 7 , endoscopic submucosal excavation (ESE) 8 , endoscopic full-thickness resection (EFTR) 9,10 , submucosal tunneling endoscopic resection (STER) 11 , and the combination of EFTR and laparoscopic approach 3,12−15 . The fundus of the stomach is considered a challenging area for endoscopic resection of tumors in muscularis propria 16 , especially when using ESD 17 , ESE, or EFTR 18,19 .…”