{"title":"新型线牵引辅助息肉切除术在十二指肠脱垂大胃息肉中的应用。","authors":"Muneshin Morita, Kotaro Waki, Yasuhito Tanaka","doi":"10.1111/den.14993","DOIUrl":null,"url":null,"abstract":"<p>Recently, innovative techniques such as the line-assisted complete closure<span><sup>1, 2</sup></span> and the reopenable clip-over-the-line method,<span><sup>3</sup></span> which involve the passage of a threaded clip through the endoscope channel, have been reported. Based on those techniques, we developed the line traction-assisted polypectomy procedure. We present a case in which this method was applied to a large gastric polyp prolapsing into the duodenum.</p><p>A 70-year-old man was referred to our hospital after a routine esophagogastroduodenoscopy (EGD) revealed a gastric polyp. Our hospital EGD showed the 40 mm pedunculated gastric polyp prolapsing into the duodenum (Fig. 1). We opted for endoscopic resection of the gastric lesion to prevent bleeding and potential obstruction (Video S1).</p><p>Initially, a 3-0 nylon line was tied at the clip, which was inserted through the channel. Subsequently, the clip with the nylon line was attached to the stalk apex of the lesion (Fig. 2a). By gently pulling on the nylon line, we successfully retracted the lesion into the stomach (Fig. 2b). Next, a 15 mm plastic tube handmade from an MTW catheter (990120111; ABIS, Hyogo, Japan) was inserted through the channel along the line, aiming to prevent the lesion from coming too close to the endoscope and to facilitate easier snaring. Following this, we inserted the Endoloop (HX-400U-30; Olympus Medical, Tokyo, Japan) and the rotatable polypectomy snare (M00561831; Boston Scientific, Marlborough, MA, USA) along the line and performed endoscopic resection (Fig. 2c–f). The patient was then discharged after 6 days without any postoperative adverse events. The pathological diagnosis was a hyperplastic polyp.</p><p>We believe that this technique is particularly effective for managing lesions that prolapse into areas such as the duodenum, diverticula, and ileocecal valve. It not only facilitates the extraction of these lesions, but also maintains adequate tension to prevent their prolapsing again.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: N/A.</p><p>Informed Consent: Informed consent was obtained to publish the patient's information and imaging data.</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>","PeriodicalId":159,"journal":{"name":"Digestive Endoscopy","volume":"37 6","pages":"712-713"},"PeriodicalIF":5.0000,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14993","citationCount":"0","resultStr":"{\"title\":\"Usefulness of novel line traction-assisted polypectomy for a large gastric polyp prolapsing into the duodenum\",\"authors\":\"Muneshin Morita, Kotaro Waki, Yasuhito Tanaka\",\"doi\":\"10.1111/den.14993\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Recently, innovative techniques such as the line-assisted complete closure<span><sup>1, 2</sup></span> and the reopenable clip-over-the-line method,<span><sup>3</sup></span> which involve the passage of a threaded clip through the endoscope channel, have been reported. Based on those techniques, we developed the line traction-assisted polypectomy procedure. We present a case in which this method was applied to a large gastric polyp prolapsing into the duodenum.</p><p>A 70-year-old man was referred to our hospital after a routine esophagogastroduodenoscopy (EGD) revealed a gastric polyp. Our hospital EGD showed the 40 mm pedunculated gastric polyp prolapsing into the duodenum (Fig. 1). We opted for endoscopic resection of the gastric lesion to prevent bleeding and potential obstruction (Video S1).</p><p>Initially, a 3-0 nylon line was tied at the clip, which was inserted through the channel. Subsequently, the clip with the nylon line was attached to the stalk apex of the lesion (Fig. 2a). By gently pulling on the nylon line, we successfully retracted the lesion into the stomach (Fig. 2b). Next, a 15 mm plastic tube handmade from an MTW catheter (990120111; ABIS, Hyogo, Japan) was inserted through the channel along the line, aiming to prevent the lesion from coming too close to the endoscope and to facilitate easier snaring. Following this, we inserted the Endoloop (HX-400U-30; Olympus Medical, Tokyo, Japan) and the rotatable polypectomy snare (M00561831; Boston Scientific, Marlborough, MA, USA) along the line and performed endoscopic resection (Fig. 2c–f). The patient was then discharged after 6 days without any postoperative adverse events. The pathological diagnosis was a hyperplastic polyp.</p><p>We believe that this technique is particularly effective for managing lesions that prolapse into areas such as the duodenum, diverticula, and ileocecal valve. It not only facilitates the extraction of these lesions, but also maintains adequate tension to prevent their prolapsing again.</p><p>Authors declare no conflict of interest for this article.</p><p>Approval of the research protocol by an Institutional Reviewer Board: N/A.</p><p>Informed Consent: Informed consent was obtained to publish the patient's information and imaging data.</p><p>Registry and the Registration No. of the study/trial: N/A.</p><p>Animal Studies: N/A.</p>\",\"PeriodicalId\":159,\"journal\":{\"name\":\"Digestive Endoscopy\",\"volume\":\"37 6\",\"pages\":\"712-713\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-01-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/den.14993\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digestive Endoscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/den.14993\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digestive Endoscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/den.14993","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Usefulness of novel line traction-assisted polypectomy for a large gastric polyp prolapsing into the duodenum
Recently, innovative techniques such as the line-assisted complete closure1, 2 and the reopenable clip-over-the-line method,3 which involve the passage of a threaded clip through the endoscope channel, have been reported. Based on those techniques, we developed the line traction-assisted polypectomy procedure. We present a case in which this method was applied to a large gastric polyp prolapsing into the duodenum.
A 70-year-old man was referred to our hospital after a routine esophagogastroduodenoscopy (EGD) revealed a gastric polyp. Our hospital EGD showed the 40 mm pedunculated gastric polyp prolapsing into the duodenum (Fig. 1). We opted for endoscopic resection of the gastric lesion to prevent bleeding and potential obstruction (Video S1).
Initially, a 3-0 nylon line was tied at the clip, which was inserted through the channel. Subsequently, the clip with the nylon line was attached to the stalk apex of the lesion (Fig. 2a). By gently pulling on the nylon line, we successfully retracted the lesion into the stomach (Fig. 2b). Next, a 15 mm plastic tube handmade from an MTW catheter (990120111; ABIS, Hyogo, Japan) was inserted through the channel along the line, aiming to prevent the lesion from coming too close to the endoscope and to facilitate easier snaring. Following this, we inserted the Endoloop (HX-400U-30; Olympus Medical, Tokyo, Japan) and the rotatable polypectomy snare (M00561831; Boston Scientific, Marlborough, MA, USA) along the line and performed endoscopic resection (Fig. 2c–f). The patient was then discharged after 6 days without any postoperative adverse events. The pathological diagnosis was a hyperplastic polyp.
We believe that this technique is particularly effective for managing lesions that prolapse into areas such as the duodenum, diverticula, and ileocecal valve. It not only facilitates the extraction of these lesions, but also maintains adequate tension to prevent their prolapsing again.
Authors declare no conflict of interest for this article.
Approval of the research protocol by an Institutional Reviewer Board: N/A.
Informed Consent: Informed consent was obtained to publish the patient's information and imaging data.
Registry and the Registration No. of the study/trial: N/A.
期刊介绍：
Digestive Endoscopy (DEN) is the official journal of the Japan Gastroenterological Endoscopy Society, the Asian Pacific Society for Digestive Endoscopy and the World Endoscopy Organization. Digestive Endoscopy serves as a medium for presenting original articles that offer significant contributions to knowledge in the broad field of endoscopy. The Journal also includes Reviews, Original Articles, How I Do It, Case Reports (only of exceptional interest and novelty are accepted), Letters, Techniques and Images, abstracts and news items that may be of interest to endoscopists.
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