Dental floss with rubber band-formed pulley traction facilitating endoscopic full-thickness resection of gastric submucosal tumor in gastric fundus

Abstract

Endoscopic full-thickness resection (EFTR) is crucial in managing gastrointestinal submucosal tumors (GISTs).¹ Different traction methods have enhanced the safety and efficacy of EFTR,^{2, 3} such as floss-assisted traction, which is widely used in endoscopic submucosal dissection and EFTR.^{4, 5} However, these methods usually provide one-way traction and inconsistent force, making it challenging to address specific tumor locations. Therefore, we developed an innovative pulley traction technique successfully applied to EFTR of a GIST in the gastric fundus (Video S1).

A patient with a 20 mm × 15 mm GIST in gastric fundus was referred for EFTR (Fig. 1a). Initially, a clip linked with dental floss was used to bring a rubber band into the stomach (Fig. 1b). On releasing the rubber band, the clip was secured to the oral mucosal edge of the tumor. A second clip was used to anchor the rubber band to the normal mucosa on the opposite side of the tumor (Fig. 1c). As the pulley traction consistently lifted the tumor, we incised the mucosa and exposed the tumor without use of a transparent cap or submucosal injection (Fig. 1d). With sufficient traction force of the pulley device, the tumor was safely excavated with complete capsule. Because the defect was transformed to be linear by the pulley traction, it was easily closed using clips (Fig. 1e). Finally, the pulley device was removed from the normal mucosa and the lesion was extracted (Fig. 1f).

Dental floss with rubber band-assisted pulley traction delivers continuous multidirectional traction in difficult locations, thus promoting safe and effective EFTR of GISTs. This method ensures a clear surgical field, prevents hemorrhage, avoids tissue damage, reduces the risk of tumor spillage, provides easy closure of the surgical defect, minimizes tumor resection time, facilitates suturing, and minimizes the likelihood of intra-abdominal infection.

Authors declare no conflict of interest for this article.