Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video)

Chung-Hsien Li, Peng-Jen Chen, Heng-Cheng Chu, Tien-Yu Huang, Yu-Lueng Shih, Wei-Kuo Chang, Tsai-Yuan Hsieh

Research output: Contribution to journalArticlepeer-review

60 Citations (Scopus)


Background: Using EMR techniques, physicians frequently remove tumors >15 mm by piecemeal resection, which is associated with an increased rate of disease recurrence and difficulty in histologically evaluating the specimen. Endoscopic submucosal dissection (ESD) of early-stage gastric cancer improves the rate of successful en bloc resection, but it is associated with more complications, such as bleeding and perforation, than conventional EMR. Objective To describe a simple technique that uses the pulley method to facilitate ESD procedures in the excision of large early-stage gastric cancers. Design Case series. Setting Tertiary medical center in Taiwan. Patients and Methods Eleven patients with early-stage gastric cancers or adenomas >20 mm underwent ESD. Interventions The pulley method with standard clips and dental floss was used to provide traction to improve visualization of the dissection plane during ESD. Main Outcome Measurement Proportion with complete en bloc resection. Results En bloc resection of the lesion was achieved in 11 patients. No perforation or emergent surgery was noted. Limitations One endoscopist performed all procedures, and only 11 patients were studied in an uncontrolled manner. Conclusions The pulley method seems to facilitate en bloc ESD of early-stage gastric cancers >20 mm. © 2011 American Society for Gastrointestinal Endoscopy.
Original languageEnglish
Pages (from-to)163-167
Number of pages5
JournalGastrointestinal Endoscopy
Issue number1
Publication statusPublished - 2011
Externally publishedYes


  • adult
  • aged
  • article
  • cancer patient
  • cancer size
  • cancer staging
  • clinical article
  • early cancer
  • endoscopic submucosal dissection
  • female
  • human
  • male
  • priority journal
  • stomach cancer
  • stomach hemorrhage
  • stomach perforation
  • surgical technique
  • treatment outcome
  • Adenocarcinoma
  • Aged
  • Aged, 80 and over
  • Dental Devices, Home Care
  • Female
  • Gastric Mucosa
  • Gastroscopy
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Stomach Neoplasms
  • Surgical Instruments
  • Taiwan


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