Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video).

BACKGROUND: Endoscopic submucosal dissection (ESD) is the standard of care for treating gastric intramucosal neoplasias in Japan. However, it is seldom performed in Western countries, mainly because it is technically very challenging. Several traction methods have been proposed to facilitate submucosal dissection, but they are usually not widely available or are difficult to apply.

OBJECTIVE: Our main aim was to evaluate the feasibility of a new method, the clip-band technique, for improving the visualization of the submucosal layer during ESD.

DESIGN: Observational, experimental, feasibility study conducted in a porcine model.

SETTING: University Hospital of the Canary Islands, Research Animal Laboratory.

PATIENTS: Animal study.

INTERVENTIONS: After completion of the circumferential cutting, a clip-band traction system was applied.

MAIN OUTCOME MEASUREMENTS: Efficacy and safety of the clip-band technique.

RESULTS: Eighteen ESDs performed in live domestic pigs were completed without any serious complications. The mean specimen size was 35.38 ± 12.17 mm, the mean cutting time was 13.06 ± 10.52 minutes, and the mean dissection time was 16.67 ± 9.01 minutes.

LIMITATIONS: The clip-band technique was not compared with the standard ESD technique.

CONCLUSIONS: This initial study shows that the clip-band traction technique is feasible and that it permits safe, effective, and relatively inexpensive gastric ESD.