2008 Volume 50 Issue 12 Pages 3062-3067
In pursuit of safe, accurate and simple method of endoscopic submucosal dissection (ESD), we devised a transparent hood attached with a mucosa gripping channel. After confirmation of its utility by animal experiments, we recognized the similar utility in the clinical setting (5 cases of early esophageal cancer). The use of this assistive device has the following advantages. (1) By lifting the separated mucosa, then reversing and pressing it backward, the mucosa-stripped plane can be observed under direct vision. This procedure not only makes hemostasis and blood vessel processing easy, thereby reducing a risk of perforation. (2) Reliable counter-traction can be applied to the submucosal tissue of the stripped plane, and separation time could he shortened. (3) We could dissect submucosal layer without using a hook knife only by gripping and pushing the excised mucosa to backward, and there was little bleeding. (4) Especially this method of gripping the excised mucosa and attaching the hood to the opening side of the excised reduces the effects of respiration and pulsation, keeps the distance of the separated part and instrument constant, and enables safe separation procedure of esophagus.
