Modified endoscopic submucosal dissection with retroflexed gastroscopy and floss traction for early hard palate neoplasia: a case report and technical description

Abstract Background Early-stage hard palate neoplasia is rare. Its unique anatomical features, including a dense mucoperiosteum that is difficult to lift and a narrow operating space, pose significant challenges in achieving complete resection using minimally invasive techniques. Case presentation A 68-year-old man with early-stage hard palate neoplasia underwent modified endoscopic submucosal dissection (ESD). A retroflexed gastroscope was used to optimise visualisation and instrument access, supplemented by a dental floss traction technique to provide stable counter-traction during dissection. The lesion was resected en bloc. Histopathological analysis confirmed the presence of clear margins. The patient had an uncomplicated recovery, resumed oral intake within 48 h, and experienced no major adverse events. Conclusion This case demonstrates that a modified ESD technique, combining retroflexed gastroscopy and dental floss traction, is a feasible, minimally invasive, and function-preserving treatment option for early-stage hard palate neoplasia, offering a new technical approach for managing such cases.