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Background: The diagnosis of early gastrointestinal cancer has progressed
dramatically with the development of the NBI system.
In addition, the development of ESD has
made it possible to remove large lesions unblocked, enabling accurate
pathological diagnosis.
Aim: Until now, we have performed various counter-traction methods to
keep a good field of view in ESD. We report the choice of the canter-traction
method according to the tumor site.
Methods: From June 2010 to December 2018, ESD was performed on 173 cases of superficial
esophageal cancer and 33 cases of hypopharyngeal cancer. After circumferential
incision using clutch cutter, the proximal end of mucosa is grasped with the
fine forceps or clip.
1. Double-channel ESD using
an EEMR-tube: Thin grasping forceps were inserted through the side channel of
the EEMR-tube. The oral end of the circumferentially incised lesion is held
with the forceps. As counter-traction is applied by gently pulling the forceps.
2. Clip with line method
combined with an Atom multipurpose tube: After circumferential incision, the
proximal end of the mucosa is grasped with the clip. Counter-traction is
applied by pulling the Atom tube after clipping.
3. Double scope ESD using
transnasal thin scope: Thin grasping forceps is inserted through the channel of
the scope. The proximal end of the mucosa is grasped with the forceps.
Counter-traction is applied by gently pulling the forceps with the thin scope.
Results: These techniques can be performed by always observing the sub
mucosal dissected layer.
These were possible to perform the
dissecting procedure safely, with no complications, such as perforation or
bleeding in every case.
These techniques are expecting to shorten
the time of ESD and avoid complications.
Conclusion: These techniques, which can be performed by always observing the
sub mucosal or sub epithelial dissected layer under counter-traction, are also
considered advantageous from viewpoint of safety.
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