The indications for endoscopic treatment have expanded in recent years,and relatively intestinal-type mucosal stomach carcinomas with a low potential for metastasis are now often resected en bloc by endoscopic submuco...The indications for endoscopic treatment have expanded in recent years,and relatively intestinal-type mucosal stomach carcinomas with a low potential for metastasis are now often resected en bloc by endoscopic submucosal dissection(ESD),even if they measure over 20 mm in size.However,ESD requires complex maneuvers,which entails a long operation time,and is often accompanied by complications such as bleeding and perforation.Many technical developments have been implemented to overcome these complications.The scope,cutting device,hemostasis device,and other supportive devices have been improved.However,even with these innovations,ESD remains a potentially complex procedure.One of the major difficulties is poor visualization of the submucosal layer resulting from the poor countertraction afforded during submucosal dissection.Recently,countertraction devices have been developed.In this paper,we introduce countertraction techniques and devices mainly for gastric cancer.展开更多
Endoscopic submucosal dissection(ESD)has been developed as a treatment for superficial gastrointestinal neoplasms,which can achieve en bloc resection regardless of the lesion size.However,ESD is technically difficult ...Endoscopic submucosal dissection(ESD)has been developed as a treatment for superficial gastrointestinal neoplasms,which can achieve en bloc resection regardless of the lesion size.However,ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract,unlike surgeons in regular surgery.It is difficult to obtain sufficient tension in the dissection plane and a good field of vision.Therefore,ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection.Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure.However,traction direction is limited in most traction methods,resulting in insufficient effect in some cases.Although traction direction is considered important,there have been few investigations of its effect.In the first half of this review,important traction methods are discussed,including traction direction.In second half,appropriate traction methods for each organ are considered.Other important considerations for traction method,such as ability to adjust traction strength,interference between traction device and endoscope,and the need for specialized devices are also discussed.展开更多
文摘The indications for endoscopic treatment have expanded in recent years,and relatively intestinal-type mucosal stomach carcinomas with a low potential for metastasis are now often resected en bloc by endoscopic submucosal dissection(ESD),even if they measure over 20 mm in size.However,ESD requires complex maneuvers,which entails a long operation time,and is often accompanied by complications such as bleeding and perforation.Many technical developments have been implemented to overcome these complications.The scope,cutting device,hemostasis device,and other supportive devices have been improved.However,even with these innovations,ESD remains a potentially complex procedure.One of the major difficulties is poor visualization of the submucosal layer resulting from the poor countertraction afforded during submucosal dissection.Recently,countertraction devices have been developed.In this paper,we introduce countertraction techniques and devices mainly for gastric cancer.
文摘Endoscopic submucosal dissection(ESD)has been developed as a treatment for superficial gastrointestinal neoplasms,which can achieve en bloc resection regardless of the lesion size.However,ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract,unlike surgeons in regular surgery.It is difficult to obtain sufficient tension in the dissection plane and a good field of vision.Therefore,ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection.Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure.However,traction direction is limited in most traction methods,resulting in insufficient effect in some cases.Although traction direction is considered important,there have been few investigations of its effect.In the first half of this review,important traction methods are discussed,including traction direction.In second half,appropriate traction methods for each organ are considered.Other important considerations for traction method,such as ability to adjust traction strength,interference between traction device and endoscope,and the need for specialized devices are also discussed.
