Kazuya Sumi

Multipoint traction technique in endoscopic submucosal dissection

re 1. A, A pale depressed lesion along the greater curvature of the stomach. Examination of biopsy specimen revealed poorly differentiated adenonoma. B, After mucosal incision, multipoint traction method was applied as follows: the snare was grasped with the clip after pulling out the scope. cope was reintroduced and advanced to the lesion, where the snare-bound clip was deployed on the anal side of the specimen. Additional clips were on the lesion to create multipoint traction. C, By pulling the snare, the submucosal layer could be clearly visualized. D, Submucosal dissection was rmed under ideal visualization, and the lesion was resected en bloc. E, A 40-mm flat erythematous lesion in the midesophagus was noted on routine scopy. F, The lesion remained unstained after iodine staining, thus raising suspicion for squamous cell neoplasia. G, After circumferential incision a water jet–assisted triangle tip knife, the multipoint traction method was applied. The scope was withdrawn, and the coagulation forceps was used to the snare. This was then advanced to the lesion, and the clip was deployed to anchor the oral edge of the specimen. Two clips were added for ipoint traction. H, The snare was pulled to create adequate traction. I, Submucosal dissection was carried out uneventfully, and the specimen esected en bloc.

New endoscopic classification of the cardiac orifice in esophageal achalasia: Champagne glass sign

Endoscopy, barium esophagram and manometry are used in the diagnosis of achalasia. In the case of early achalasia, characteristic endoscopic findings are difficult to recognize. As a result, the diagnosis of achalasia is often made several years after symptom onset. Therefore, we examined the endoscopic findings of the cardiac orifice in achalasia and propose a new classification.