Methods: ESTD was attempted in six consecutive patients with gastric neoplasia with clinical indications for endoscopic resection from August to November 2012 in our institute. For

the gastric superficial neoplasia, the large ones were defined as lesions with length ≥25 mm and width ≥30 mm. Routine ESD equipment and accessories were used in the operation. After the margin of the lesion was marked, one submucosal tunnel created by submucosal dissection from oral incision to anal incision. Finally, bilateral dissection was performed to remove the lesion completely. After completion of ESTD, preventive coagulation was routinely performed R428 ic50 for all visible vessels on the artificial ulcer using hemostatic forceps or argon plasma coagulation. Results: For the six lesions, the maximum diameter was from 40 mm to 50 mm (mean 44 mm). The operation time ranged from 35 minutes to 98 minutes (mean 73 minutes). En bloc resection was achieved without complications in all the lesions. After ESTD, the pathology demonstrated that two lesions were high-grade DAPT concentration intraepithelial neoplasia and four lesions were gastric cancer, which were resected

completely but one with positive basal margins. The patient with residual lesion was performed surgery 12 days later, and then the pathology demonstrated no residual cancer. Conclusion: ESTD technique is feasible and appears to be efective and safe for removal large gastric superficial neoplasia. Its efficacy and safety still need to be further confirmed by larger, comparative studies. Key Word(s): 1. ESTD; 2. gastric neoplasia; Presenting Author: YING KIT LEUNG Corresponding Author: YING KIT LEUNG Affiliations: Precious MCE Blood Hospital Objective: performance of SBE uses the hooking maneuver to anchor the tip of scope to the mucosa and is often unsuccessful because the mucosa is slippery resulting in sliding back of the scope during advancement of the overtube. Double balloon enteroscopy uses an additional balloon at the tip of the scope to achieve anchorage but is also often not very secure. The aim of this

study is to use a novel method to prevent the scope from slipping back during insertion of the overtube when the overtube balloon is deflated. Methods: We use a cap that can be fitted snugly to the tip of the scope. The cap obscures about 5% of the visual field during the procedure. When the overtube balloon is to be deflated prior to overtube advancement over the shaft of the scope, the tip of the scope is impacted against the small bowel mucosal and maximal suction applied. The tip of the scope is firmly adhered to the mucosa as negative pressure is applied, preventing the scope from slipping. The suction is released when the balloon is reinflated. The cycle is repeated during advancement of the scope. Results: A total of thirteen patients underwent SBE in this manner, twelve retrograde and one antegrade. Indications of the procedure: abdominal pain, bleeding, ulceration and Crohn’s disease.