A Novel Therapeutic Thin Endoscope Facilitates Gastric Endoscopic Submucosal Dissection in the Cardia and Pylorus: A Case Series Study (With Video).

Endoscopic submucosal dissection (ESD) is an established technique for treating superficial gastric neoplasms. However, performing ESD in the cardia and pylorus remains technically challenging due to the narrow lumens and steep angulations. Recently, a novel therapeutic thin endoscope, featuring a 7.9-mm outer diameter, 160° downward angulation, 3.2-mm working channel, and water jet function, was developed. We aimed to evaluate the feasibility of this novel endoscope for ESD in the cardia and pylorus. We retrospectively reviewed the data from gastric ESD cases in the cardia and pylorus using this novel endoscope at a single tertiary care center between March 2023 and September 2024. Clinical characteristics, procedural details, and treatment outcomes were analyzed. A total of 20 lesions (10 in the cardia, 10 in the pylorus) were included. The median lesion size was 15 mm (interquartile range: 10-30 mm). En bloc resection was successfully achieved in all cases without any adverse events. None of the cases required traction devices. Retroflexion was unnecessary in approximately half of the cases. In conclusion, this novel therapeutic thin endoscope facilitated en bloc resection without any adverse events in all cases; suggesting its feasibility for gastric ESD in anatomically complex regions characterized by narrow lumens and steep angulations.