Efficacy of the"clip with the floss"method during endoscopic submucosal dissection for early gastric angle cancer

Objective To investigate the therapeutic effect and safety of the"clip with the floss"method during endoscopic submucosal dissection for early gastric angle cancer. Methods A total of 27 gastric angle lesions diagnosed as early gastric cancer were treated by ESD.They were randomized to two groups, routine ESD group and"clip with the floss"group.The procedure time, complication events, en-block resection rate and complete resection rate were compared between the two groups. Also, the learning time was divided to two stages and the learning curve was studied according to the resected specimen areas per minute. Results The en block rate was 85.7%(12/14) in the routine ESD group and 100.0%(13/13) in the"clip with the floss"group. The procedure time in the"clip with the floss"group was significantly less than that in the routine ESD group(the median time 30 min VS 40 min, P=0.011). Perforation and the post operative bleeding did not occur in either group. The ESD learning curving during the first learning period and the mean resected specimen (area/min) in the"clip with the floss"group were larger than routine ESD group(30±6 mm2/min VS 20±5 mm2/min, P=0.01). However, no difference presented during the second learning period between the two groups. Conclusion "Clip with the floss"method during endoscopic submucosal dissection for early gastric angle cancer as a novel procedure is safe, efficacious and worthy to recommend to beginning learners. Key words: Therapeutic endoscopy; Stomach neoplasms; Endoscopic submucosal dissection; Traction