Grasp-and-lift technique – Novel cold forceps polypectomy technique for a gastric foveolar-type adenoma

Abstract

Endoscopic resection is the treatment of choice for gastric foveolar-type adenomas with a raspberry-like appearance (GFA-R) that are small lesions with a low-grade malignancy potential.^{1, 2} However, an endoscopic treatment strategy for GFA-Rs has not been established, and resection methods vary among endoscopists.^{1, 3, 4} Cold forceps polypectomy (CFP) is a suitable method for resecting small lesions and carries a lower risk compared to endoscopic mucosal resection/endoscopic submucosal dissection (EMR/ESD); however, the en bloc resection rate falls drastically for larger lesions and reaches rates as low as 70% for lesions sized 5 mm.⁵ Therefore, a low-risk en bloc resection method is desirable. Here, we describe a “grasp-and-lift technique” as a novel method for GFA-R en bloc resection using CFP. A 34-year-old man underwent endoscopic resection of a 6 mm GFA-R located at the greater curvature of the middle third of the stomach (Fig. 1a). Using large forceps (Radial Jaw 4 Jumbo, Boston Scientific), we grasped the base of the lesion along with the background mucosa while suctioning air (Fig. 1b,c). The lesion was removed carefully by lifting it toward the contralateral wall (Fig. 1d) and retrieving it along with the endoscope without pulling the lesion through the forceps channel to avoid damage (Fig. 1e). Evaluation of the mucosal defect revealed no residual tumor (Fig. 1f), and the pathological examination confirmed curative resection (Fig. 2). Here, we present the grasp-and-lift technique, a novel method in which a 6 mm GFA-R was successfully resected using CFP. This method can potentially remove lesions with a base smaller than the length of the forceps. Compared to traditional CFP techniques, this technique may offer higher en bloc resection rates. Furthermore, it is less time-consuming, more economical, and has a lower risk than EMR/ESD (Video S1).

Authors declare no conflict of interest for this article.

Approval of the research protocol by an Institutional Reviewer Board: This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Juntendo University School of Medicine (approval number: H19-0050).

Informed Consent: All patients had given their informed consent before treatment for this study.

Registry and the Registration No. of the study/trial: N/A.

Animal Studies: N/A.