Facilitating retroflexed endoscopic full-thickness resection through loop-mediated or rope-mediated countertraction (with videos)

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• 作者：Jiaoyang Lu ; MD¹ ; ³ ; ^&lowast ; ; Taotao Jiao ; MD² ; ^&lowast ; ; Yanmei Li ; MD³ ; ⁴ ; Minhua Zheng ; MD ; PhD¹ ; ^{zheng_minhua@yeah.net" class="auth_mail" title="E-mail the corresponding author} ; Xuefeng Lu ; MD³ ;
• 关键词：EFTR ; endoscopic full-thickness resection ; ESD ; endoscopic submucosal dissection ; IT ; insulation tip ; OTSC ; over-the-scope clip ; PPI ; proton pump inhibitor ; SMT ; submucosal tumor
• 刊名：Gastrointestinal Endoscopy
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：83
• 期：1
• 页码：223-228
• 全文大小：1703 K

文摘

Endoscopic full-thickness resection (EFTR) is difficult to perform in a retroflexed fashion in the gastric fundus and lesser curvature. Here we describe two simple methods to provide countertraction and thereby facilitate dissection.

Methods

In this retrospective cohort study, 62 patients diagnosed as having gastric submucosal tumors in the fundus or in the lesser curvature received EFTR with or without countertraction methods. For the clip-with-thread method, a clip tied with surgical suture was anchored on the distal edge of the tumor to provide countertraction; for the loop-assisted method, a snare placed on the transparent cap beforehand was adopted to grasp the tumor to provide countertraction.

Results

Mean operative time was significantly reduced in the thread-with-clip group and loop-assisted group (45 minutes, 40 minutes, respectively) compared with the time needed in the traditional EFTR group (85 minutes). Intraoperative pneumoperitoneum occurred regularly among the 3 groups because of iatrogenic perforation, but fewer patients in the thread-with-clip group and loop-assisted group (23%, 18%, respectively) needed abdominal puncture to relieve free air and stabilize life signs compared with patients in the traditional EFTR group (63%). A reduced occurrence of high fever after surgery may contribute as another advantage from accelerated dissection. Both techniques did not jeopardize oncologic safety during short-term follow-up.

Conclusions

Both the thread-with-clip method and loop-assisted method provide effective countertraction and offer faster and safer gastric EFTR in difficult anatomic locations.