Endoscopic submucosal dissection (ESD) has been widely used for resection of esophageal neoplastic lesions, but there are still technical challenges in treating large ones. Based on the development of tunneling technique, we report the first series in which the new technique of endoscopic submucosal tunnel dissection (ESTD) was used to remove large lesions in the esophagus. ESTD was attempted in five consecutive patients with esophageal lesions for which resection was indicated. In the operation, once the margin of the lesions had been marked, a submucosal tunnel was created by submucosal dissection from the oral incision to the anal incision. Bilateral resection was then performed to remove the lesion completely. The average length of the five lesions was 5.7 cm, and their extent as a proportion of the whole circumference of the lumen ranged from one third to four fifths. Operative time ranged from 50 minutes to 120 minutes (mean, 77 minutes). En bloc resection with negative lateral and basal margins was achieved in all lesions without complications.

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Background: Neuroendocrine tumors (NETs) are rising in prevalence, particularly with the rectal area.This study evaluated and compared the safety and effectiveness of hybrid endoscopic submucosal dissection (ESD) with those of ESD for rectal NETs and risk factors associated with incomplete endoscopic resection.Methods: A total of 272 consecutive patients who underwent ESD or hybrid ESD for rectal NETs at the Chinese PLA General Hospital in the period from February 2011 to September 2018 were involved in this study. Data were collected from clinical and endoscopic databases. The procedure time, en bloc resection, complete resection, complication, and recurrence rates were evaluated.Results: In the hybrid ESD group were 111 patients (who had 119 lesions between them), with a further 161 patients (164 lesions) in the ESD group. No significance was found in baseline characteristics between the two groups. Hybrid ESD had a significantly shorter mean procedure time than ESD (13.2±8.3 vs. 18.1±9.7 min, P=0.000). Hybrid ESD showed similar en bloc resection (99.2% vs. 98.2%; P=0.373), complete resection (94.1% vs. 90.9%, P=0.641), and postprocedural bleeding (2.5% vs. 0.6%, P=0.313) rates to ESD. Univariate and multivariate analysis showed that higher histopathological grade was associated with incomplete resection.Conclusions: For rectal NET, both ESD and hybrid ESD are effective and safe forms of treatment.Hybrid ESD provides an alternative option in the treatment of rectal NETs. Further developments are needed to improve the complete resection rate, especially concerning tumors with higher histopathological grade.

Aim To evaluate the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) for resection of large superficial gastric lesions (SGLs). Methods The clinicopathological records of patients performed with ESTD or endoscopic submucosal dissection (ESD) for SGLs between January 2012 and January 2014 were retrospectively reviewed. 7 cases undergoing ESTD were enrolled to form the ESTD group. The cases were individually matched at a 1 : 1 ratio to other patients performed with ESD according to lesion location, ulcer or scar findings, resected specimen area, operation time and operators, and the matched cases constituting the ESD group. The treatment outcomes were compared between the two groups. Results The mean specimen size was 46 mm. 10 lesions were located in the cardia and 4 lesions in the lesser curvature of the lower gastric body. En bloc resection was achieved for all lesions. The mean ESTD resection time was 69 minutes as against 87.7 minutes for the ESD (P = 0.01). The mean resection speed was faster for ESTD than for ESD (18.86 mm2/min versus 13.76 mm2/min, P = 0.03). There were no significant differences regarding the safety and curability during the endoscopic follow-up (mean 27 months). Conclusions ESTD is effective and safe for the removal of SGLs and appears to be an optimal option for patients with large SGLs at suitable sites.