Endoscopic Submucosal Dissection Using the “Yo-Yo Technique”

Abstract

Background

Endoscopic submucosal dissection (ESD) has been increasingly used for en bloc resection of gastrointestinal lesions. One of the main difficulties during ESD is to mobilize the partially resected lesion, leading to increased procedure time and complication rates. We developed a new “yo-yo technique”, that allows a fast, cheap and easy way for, not only pulling, but also pushing the lesion during ongoing ESD.

Aims

To describe the feasibility and safety of the “yo-yo technique” for ESD.

Procedure

After marking and lifting the lesion, incision and partial dissection are performed. Then, a hemoclip is placed in the already dissected edge of the lesion. Afterwards, a conventional snare is introduced through the nose into the stomach. Using a forceps, the hemoclip is grabbed with the snare. Due to the moderate stiffness of the snare, the edge of the lesion can be pulled or pushed during ongoing ESD, independently from the endoscope's movements. This increases the visualization of the dissection plane, reducing complications rate and procedure time.

Results

The pull and push movements of the snare allow easier ESD with better access to the submucosal space and to the lesions' distal margins. Lesions can be successfully and safely removed and en block resection achieved using the “yoyo technique”. The presence of the hemoclip in the resected specimen permits a precise anatomopathological orientation.

Conclusion

The “yo-yo technique” for ESD is feasible, cheap and safe allowing full mobilization of the lesion.