Chen Peng-Jen, Chu Heng-Cheng, Chang Wei-Kuo, Hsieh Tsai-Yuan, Chao You-Chen
Taipei, Taiwan.
Gastrointest Endosc. 2008 Jan;67(1):128-32. doi: 10.1016/j.gie.2007.07.021. Epub 2007 Dec 3.
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.
To describe a simple technique of using internal traction to facilitate endoscopic submucosal dissection (ESD) procedures in the excision of large, early gastric cancers.
Case series.
A tertiary medical center in Taiwan.
Eight patients with early gastric cancers larger than 20 mm underwent ESD.
A standard hemoclip modified with surgical suture was used to provide traction to improve visualization of the dissection plane during ESD.
Proportion with complete en bloc resection.
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.
One endoscopist performed all procedures, and only 8 patients were studied in an uncontrolled manner.
The internal traction method appears to facilitate en bloc ESD of early gastric cancers larger than 20 mm.
内镜黏膜切除术（EMR）技术治疗上消化道小病变成功率高；然而，大于15毫米的肿瘤常采用分片切除，这与疾病复发率增加及标本组织学评估困难相关。
描述一种在切除大型早期胃癌时使用内部牵引以促进内镜黏膜下剥离术（ESD）操作的简单技术。
病例系列。
台湾一家三级医疗中心。
8例大于20毫米的早期胃癌患者接受了ESD。
使用经手术缝线改良的标准止血夹提供牵引，以改善ESD过程中剥离平面的可视化。
整块切除的比例。
8例患者实现了病变的整块切除。1例患者因ESD未获得足够的安全切缘而接受了额外手术。
所有操作均由一名内镜医师完成，且仅对8例患者进行了非对照研究。
内部牵引法似乎有助于对大于20毫米的早期胃癌进行整块ESD。
