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HOME > Clin Endosc > Volume 59(5); 2026 > Article
Video of Issue Successful gastric endoscopic submucosal dissection using an external second bending device
Daisuke Minezakiorcid, Koshiro Tsutsumiorcid, Ryo Ogawaorcid, Kazuhiro Mizukamiorcid
Clinical Endoscopy 2026;59(5):855-856.
DOI: https://doi.org/10.5946/ce.2025.262
Published online: December 23, 2025

Department of Gastroenterology, Oita University Faculty of Medicine, Yufu, Japan

Correspondence: Daisuke Minezaki Department of Gastroenterology, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan E-mail: d-minezaki@oita-u.ac.jp
• Received: July 30, 2025   • Revised: October 9, 2025   • Accepted: October 13, 2025

© 2026 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Endoscopic submucosal dissection (ESD) of the greater curvature of the gastric body is technically challenging due to its limited stability.1,2 In the forward view, the endoscope often floats within the lumen, rendering it susceptible to displacement by respiratory movements. Retroflexion may be attempted; however, considerable forward pressure is required in the lower gastric body, resulting in paradoxical scope movements and impaired maneuverability.
The AttachBend (Fujifilm) is a novel external device that creates a second bending point at the distal end of a thin therapeutic endoscope (EG-840TP; Fujifilm) (Fig. 1). The angle of the second bend could be easily adjusted using the handle at the proximal end. We report a successful ESD utilizing this device for management of lesions in the greater curvature of the lower gastric body (Video 1).
An 82-year-old woman presented with a 20-mm depressed lesion (Fig. 2). ESD was performed using an EG-840TP with the device set to down-angulation direction. For insertion, the device was covered with a transparent film that to smooth the surface, and even after multiple reinsertions, no pharyngeal or esophageal injuries were observed. Combining the down-angulation of the second bend with the up-angulation of the scope created an S-shaped configuration that maintained several centimeters of the shaft in continuous mucosal contact (Fig. 3). This setup significantly enhanced the scope stability and minimized the effects of respiratory movements. A mucosal flap was created on the oral side, followed by a circumferential incision. Submucosal dissection was performed in the forward view. The lesion was successfully resected en bloc without adverse events.
This external device improved the maneuverability in anatomically unfavorable locations, enabling safer and more efficient treatments. Although a comparison with underwater ESD or traction devices requires further study, the additional cost may be justified in selected difficult cases where stable ESD cannot otherwise be achieved.
Video 1. Endoscopic submucosal dissection of the greater curvature of the lower gastric body using a novel external bending device.
A video related to this article can be found online at https://doi.org/10.5946/ce.2025.262.
Fig. 1.
AttachBend (Fujifilm) is an external attachment device designed to provide an additional bending point to the distal portion of a therapeutic endoscope, with a maximum angulation of 70°. The image on the left displays the control lever of the device mounted on the endoscope handle. The upper-right image demonstrates the configuration when the device is attached in the up-angulation direction, whereas the lower-right image demonstrates the attachment in the down-angulation direction.
ce-2025-262f1.jpg
Fig. 2.
Case description. A 20-mm lesion was located at the greater curvature of the lower gastric body.
ce-2025-262f2.jpg
Fig. 3.
Comparison of scope positioning with and without the use of the novel device. (A) Conventional approach without the device, where the endoscope tip tends to float and has limited mucosal contact. (B) When the device was mounted in the down-angulation direction and upward scope angulation was applied, the scope achieved greater contact with the mucosal surface, resulting in a more stable and horizontal view.
ce-2025-262f3.jpg
  • 1. Kim M, Jeon SW, Cho KB, et al. Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study. Surg Endosc 2013;27:1372–1378.ArticlePubMedPDF
  • 2. Yamamoto Y, Kikuchi D, Nagami Y, et al. Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: review of the literature and recommendations from experts. Dig Endosc 2019;31 Suppl 1:4–20.ArticlePubMedPDF

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        Successful gastric endoscopic submucosal dissection using an external second bending device
        Clin Endosc. 2026;59(5):855-856.   Published online December 24, 2025
        DOI: https://doi.org/10.5946/ce.2025.262
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      Successful gastric endoscopic submucosal dissection using an external second bending device
      Image Image Image
      Fig. 1. AttachBend (Fujifilm) is an external attachment device designed to provide an additional bending point to the distal portion of a therapeutic endoscope, with a maximum angulation of 70°. The image on the left displays the control lever of the device mounted on the endoscope handle. The upper-right image demonstrates the configuration when the device is attached in the up-angulation direction, whereas the lower-right image demonstrates the attachment in the down-angulation direction.
      Fig. 2. Case description. A 20-mm lesion was located at the greater curvature of the lower gastric body.
      Fig. 3. Comparison of scope positioning with and without the use of the novel device. (A) Conventional approach without the device, where the endoscope tip tends to float and has limited mucosal contact. (B) When the device was mounted in the down-angulation direction and upward scope angulation was applied, the scope achieved greater contact with the mucosal surface, resulting in a more stable and horizontal view.

      Fig. 1.

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      Fig. 3.

      Successful gastric endoscopic submucosal dissection using an external second bending device
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