Usefulness of the clip-flap method of endoscopic submucosal dissection: A randomized controlled trial

Figure 1 Flow diagram of this study. We enrolled 117 patients who were scheduled to undergo ESD for gastric tumors from May 2015 to October 2016. A total of 104 patients were randomized to the conventional and the clip-flap groups. After ESD, ten patients had a lesion outside the inclusion criteria of early-stage gastric cancer. ESD: Endoscopic submucosal dissection.

Figure 2 Clip-flap methods. A: The mucosal circumference incision of gastric tumor is performed in the conventional manner; B: A deeper cut is made at the point attached the endoclip; C: The endoclip is attached to the exfoliated mucosa. The head of the endoclip falls slightly toward the gastric lumen, allowing the attachment to be easily inserted under the endoclip; D: The attachment is inserted under the endoclip, and then the mucosa and submucosal layer are elevated by the endoclip; E: The gastric tumor is dissected with the endoknife under direct vision.