TY - JOUR
T1 - Efficacy of traction, using a clip-with-thread, for esophageal endoscopic submucosal dissection for esophageal lesions with fibrosis in an ex vivo pig training model
AU - Esaki, Mitsuru
AU - Minoda, Yosuke
AU - Ihara, Eikichi
AU - Sakisaka, Seiichiro
AU - Tsuruta, Shinichi
AU - Hosokawa, Taizo
AU - Wada, Masafumi
AU - Hata, Yoshitaka
AU - Suzuki, Sho
AU - Iwao, Aya
AU - Yamakawa, Shun
AU - Irie, Akira
AU - Akiho, Hirotada
AU - Ogawa, Yoshihiro
N1 - Publisher Copyright:
© 2020 by The Turkish Society of Gastroenterology.
PY - 2020
Y1 - 2020
N2 - Background/Aims: Endoscopic submucosal dissection (ESD) of recurrent esophageal carcinoma is technically difficult to perform due to submucosal fibrosis that develops after definitive chemoradiation therapy. Therefore, our aim was to evaluate the usefulness of clipwith- thread traction for ESD of esophageal lesions with submucosal fibrosis. Materials and Methods: Four endoscopists excised 16 lesions by ESD in an ex vivo pig training model. Mock lesions (30 mm in diameter) were created, including a 10-mm area of submucosal fibrosis in the center of each lesion. Each endoscopist performed two ESDs with traction (ESD-T) and two without traction (ESD-N). The primary outcome was the time required for submucosal dissection. Secondary outcomes were the rate of en bloc (complete) resection and perforation during the procedure, and the total amount of solution injected. Results: All esophageal ESDs were completed. The median dissection time was significantly shorter for the ESD-T group (median 12.5 min, interquartile range 10.2-14.5) when comparing to the ESD-N group (median 18.0 min, interquartile range 14.6-19.2) (P=0.040). The en bloc resection rate was 100% in both groups, with a rate of complete resection of 87.5% and a rate of perforation of 37.5% for both groups. The median amount of solution injected was not significantly different between the ESD-T (18.0 ml) and ESD-N (20.5 ml) groups (P=0.526). Conclusion: Clip-with-thread traction improved the performance of ESD for lesions with submucosal fibrosis. However, the method might not reduce the risk of perforation, which remains an important clinical issue to resolve.
AB - Background/Aims: Endoscopic submucosal dissection (ESD) of recurrent esophageal carcinoma is technically difficult to perform due to submucosal fibrosis that develops after definitive chemoradiation therapy. Therefore, our aim was to evaluate the usefulness of clipwith- thread traction for ESD of esophageal lesions with submucosal fibrosis. Materials and Methods: Four endoscopists excised 16 lesions by ESD in an ex vivo pig training model. Mock lesions (30 mm in diameter) were created, including a 10-mm area of submucosal fibrosis in the center of each lesion. Each endoscopist performed two ESDs with traction (ESD-T) and two without traction (ESD-N). The primary outcome was the time required for submucosal dissection. Secondary outcomes were the rate of en bloc (complete) resection and perforation during the procedure, and the total amount of solution injected. Results: All esophageal ESDs were completed. The median dissection time was significantly shorter for the ESD-T group (median 12.5 min, interquartile range 10.2-14.5) when comparing to the ESD-N group (median 18.0 min, interquartile range 14.6-19.2) (P=0.040). The en bloc resection rate was 100% in both groups, with a rate of complete resection of 87.5% and a rate of perforation of 37.5% for both groups. The median amount of solution injected was not significantly different between the ESD-T (18.0 ml) and ESD-N (20.5 ml) groups (P=0.526). Conclusion: Clip-with-thread traction improved the performance of ESD for lesions with submucosal fibrosis. However, the method might not reduce the risk of perforation, which remains an important clinical issue to resolve.
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U2 - 10.5152/tjg.2020.19207
DO - 10.5152/tjg.2020.19207
M3 - Article
C2 - 32009615
AN - SCOPUS:85078838987
VL - 31
SP - 58
EP - 64
JO - Turkish Journal of Gastroenterology
JF - Turkish Journal of Gastroenterology
SN - 1300-4948
IS - 1
ER -