Titanium Clip and Dental Floss Traction Assisted Endoscopic Submucosal Dissection Resection for Early Gastric Cancer

Endoscopic mucosal dissection (ESD) is used to diagnose and treat early gastrointestinal tumors. ESD allows for curative resection of superficial gastrointestinal lesions, with the advantage of treating multiple lesions in a single session and performing repeated procedures when necessary. However, ESD operations require a large field of view, and when bleeding occurs, the restricted space may make it difficult to locate and control the bleeding site in a timely manner. Larger wounds created during ESD procedures require even more space, and while tunneling technology has emerged, it is still considered less direct compared to having an additional hand to open the peeled mucosal window. Although transparent caps can help expose the surgical field, their effectiveness is limited when dealing with larger wounds. Various auxiliary techniques have been explored to address these challenges. In our endoscopic diagnosis and treatment center, we have been using ESD for many years, performing approximately 200 cases annually of gastric mucosal lesions and submucosal masses. The vertical and horizontal margins were negative, and the resection was complete, avoiding surgical treatment. Among these cases, 10 involved the use of dental floss-assisted traction during ESD. Dental floss assistance, as one of the auxiliary ESD methods, has the advantages of convenience and ease of use, which facilitates the imaging process. By securing the tail of a titanium clip with dental floss, the procedure becomes more efficient and adaptable. The traction wire can be pulled as needed during the operation, helping to expose and control the field of view. This significantly supplements the effect of the transparent cap, which may be less effective in larger wound areas. Dental floss traction acts as a third hand, expanding the operational space, facilitating endoscopic maneuvers, reducing surgical time, and minimizing the risk of side injuries during the treatment.