Application of in vivo traction-assisted resection of large gastric mucosal lesions: a case series (with video).

BACKGROUND

Traction-assisted techniques have been widely applied in gastric endoscopic submucosal dissection (ESD), enabling more stable and distinct visualization of the submucosa through mucosal elevation. However, there remains a notable scarcity of reports on their application in managing large gastric mucosal lesions. Here, we present a case series introducing the application of elastic ring traction-assisted resection for large gastric mucosal lesions and evaluate its efficacy and safety.

METHODS

This prospective case series study enrolled 13 patients with large gastric mucosal lesions (> 3.0 cm in diameter) who underwent an in vivo elastic ring traction-assisted ESD procedure between April 2023 and September 2024 at our endoscopic center.

RESULTS

With the application of elastic ring traction, the mean dissection speed was 34.70 mm2/min and the mean dissection time for ESD was 74.62 min, even in cases with relatively large tumor sizes. During and after the operation, no perforation occurred in the elastic ring traction-assisted ESD procedures, and the intraoperative bleeding rate was 7.69%.

CONCLUSION

In the treatment of large gastric mucosal lesions exceeding 3.0 cm in diameter, elastic ring traction-assisted ESD demonstrates effectiveness and safety. However, further prospective controlled studies are needed to comprehensively verify the reliability of this method.