Endoscopic submucosal tunnel dissection versus conventional endoscopic submucosal dissection for early gastric cancers:
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and Other Interventional Techniques
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Endoscopic submucosal tunnel dissection versus conventional endoscopic submucosal dissection for early gastric cancers: outcomes of 799 consecutive cases in a single institution Toshiyasu Ojima1 · Katsunari Takifuji1 · Masaki Nakamura1 · Mikihito Nakamori1 · Keiji Hayata1 · Junya Kitadani1 · Hiroki Yamaue1 Received: 6 April 2019 / Accepted: 24 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancers (EGCs), but because of the obscured view and difficulty in submucosal lifting it is time consuming and poses high risk of perforation and bleeding in large lesions. In endoscopic submucosal tunnel dissection (ESTD) technique, good visualization of the submucosal layer can be achieved in the tunnel, it is, therefore, easy to discern the muscularis propria and visualize the vessels in the submucosal area. This study aims to evaluate the technical feasibility, efficacy, and safety of ESTD in comparison with conventional ESD (cESD) technique for treatment of EGCs. Methods This is a single-center retrospective study of 799 consecutive patients with EGCs who underwent ESD. ESTD (n = 141) were performed between 2015 and 2018 and cESD (n = 658) were performed between 2003 and 2015. Using propensity scores to strictly balance the significant variables, we compared treatment outcomes. Results After matching, we enrolled 444 patients (n = 111 in ESTD group, n = 333 in cESD group). The resection speeds for lesions of the ESTD were faster than those of cESD (19.3 mm2/min versus 17.7 mm2/min, P = 0.009). There was no need to use additional countertraction by clip-with-line technique or snare for the submucosal dissection in the ESTD procedure. The incidence of perforation was significantly higher in the cESD group (6.0%) than in the ESTD group (0.9%) (P = 0.035). Among 799 patients, four patients who received non-curative ESD had recurrence of gastric cancer. Conclusion ESTD technique is a safe and feasible treatment procedure for EGCs. It presents many theoretical advantages and may have definite benefits over cESD. ESTD may, therefore, be considered as the standard endoscopic treatment for EGCs. Keywords Early gastric cancers · Endoscopic submucosal dissection · Endoscopic submucosal tunnel dissection · Minimally invasive surgery Endoscopic submucosal dissection (ESD) is standard therapy for early gastric cancers (EGCs). Its superiority over endoscopic mucosal resection in terms of curative resection and local recurrence has been demonstrated. Owing to obscured view and difficulty in submucosal lifting, however, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07849-1) contains supplementary material, which is available to authorized users. * Toshiyasu Ojima tojima@wakayama‑med.ac.jp 1
Second Department of Surgery, Wakayama Medical University School of Medicine, 811‑1 Kimiider
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