Efficacy of endoscopic submucosal tunnel dissection versus endoscopic submucosal dissection for superficial esophageal neoplastic lesions: a systematic review and meta-analysis

Zhang, Ting; Zhang, Hao; Zhong, Furui; Wang, Xuan

doi:10.1007/s00464-020-07925-6

Cited by 15 publications

(11 citation statements)

References 20 publications

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“…There was no significant difference between the 2 procedures in rates of postprocedure esophageal strictures. The ESTD procedure time was significantly shorter than the ESD procedure length (standardized mean difference: −0.57; 95% CI: −0.95 to −0.19; P =0.003) 92…”

Section: Endoscopic Submucosal Tunnel Dissection (Estd)mentioning

confidence: 92%

“…The ESTD procedure time was significantly shorter than the ESD procedure length (standardized mean difference: −0.57; 95% CI: −0.95 to −0.19; P = 0.003). 92 Though data on ESTD is somewhat limited, there is substantial evidence that it is feasible, safe, and efficacious. Furthermore, some of the data indicates that it is superior to ESD in these regards.…”

Section: Endoscopic Submucosal Tunnel Dissection (Estd)mentioning

confidence: 99%

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New Applications for Submucosal Tunneling in Third Space Endoscopy

Karanfilian

Kahaleh

2022

Journal of Clinical Gastroenterology

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Third space endoscopy (TSE), a type of natural orifice transluminal endoscopic surgery, was first introduced a decade ago, and since then, has revolutionized the field of therapeutic endoscopy. TSE involves tunneling into the submucosal space between the intestinal mucosa and the muscularis propria. By accessing this “third space,” endoscopists can perform minimally invasive myotomies, resections, and dissections while maintaining the mucosa and preventing full-thickness perforation. TSE procedures can be used to treat motility disorders as well as neoplasms throughout the gastrointestinal tract, which were traditionally conditions that would require open or laparoscopic surgery. The main TSE procedures include peroral endoscopic myotomy, gastric peroral endoscopic myotomy, Zenker peroral endoscopic myotomy, submucosal tunneling for endoscopic resection, endoscopic submucosal tunnel dissection, peroral endoscopic tunneling for restoration of the esophagus, and per-rectal endoscopic myotomy. Some of those procedures have now been accepted as viable alternative to surgical techniques due to their limited invasiveness, safety and cost. This review will explore the different techniques recently added to our arsenal while describing their potential efficacy and limitations.

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Section: Endoscopic Submucosal Tunnel Dissection (Estd)mentioning

confidence: 92%

Section: Endoscopic Submucosal Tunnel Dissection (Estd)mentioning

confidence: 99%

New Applications for Submucosal Tunneling in Third Space Endoscopy

Karanfilian

Kahaleh

2022

Journal of Clinical Gastroenterology

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“…The esophageal tunnel strategy described in 2013 15 with limited incisions above and below the lesion allows very good submucosal exposure once the endoscope is introduced into the submucosal plane of the tunnel. Comparative retrospective studies then demonstrated the superiority of this tunneling strategy compared with the standard strategy 16 17 18 . Moreover, the presence of the endoscope in the tunnel spontaneously creates triangulation by imposing separation of the mucosa from the muscular plane.…”

Section: Submucosal Dissectionmentioning

confidence: 95%

Endoscopic submucosal dissection: How to be more efficient?

et al. 2021

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Endoscopic submucosal dissection (ESD) allows an “en bloc” resection with safety margins (R0 resection) regardless of the size of the lesion. However, while R0 brings a real benefit for the patient, it is not considered sufficient by many experts to justify the technical difficulties and the longer procedure time compared to piecemeal mucosectomy. The aims of this review are to provide several technical and strategical tips to help you save time and become comfortable during ESD procedures. ESD is divided into several intertwined phases: injection, incision, access to the submucosae, and submucosal dissection itself. During injection there are some mistakes that should not be made: a superficial injection, or on the contrary, a too deep injection. A good needle and good injection technique are mandatory. Some techniques, such as repeated injection or prolonged lifting solution, can help maintain the lift. After this step, mucosal incision can be made, taking care to have a good margin to allow an R0 resection. Starting the mucosal incision from a small point allows calibration of the depth of the incision and then obtaining a nice incision. Trimming is also very important to widen submucosal access. Then comes the submucosal dissection itself. Strategies such as the tunnel strategy or the pocket creation method can help to facilitate dissection, but more importantly, traction systems have become unavoidable, especially in the stomach and colon. Most common complications are bleeding and perforation, and they usually can be managed endoscopically.

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“…A propensity score matching analysis[ 58 ] showed that ESTD had a shorter median ESD procedure time (38.0 min vs 48.0 min; P = 0.006) and lower muscle injury rate (28.9% vs 52.6%; P = 0.036) compared with conventional ESD. Furthermore, a meta-analysis including 17 studies[ 59 ] showed that ESTD had significantly higher en bloc resection rate, shorter ESD procedure time, and lower muscle injury rate. In ESTD, the endoscope tip is held by the submucosal tunnel, which allows stabilization of the endoscope and a parallel approach to the muscle layer.…”

Section: Traction Methods Associated With Lesion Sitementioning

confidence: 99%

Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

Nagata¹

2022

WJG

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Endoscopic submucosal dissection (ESD) has been developed as a treatment for superficial gastrointestinal neoplasms, which can achieve en bloc resection regardless of the lesion size. However, ESD is technically difficult because endoscopists cannot bring their hand into the gastrointestinal tract, unlike surgeons in regular surgery. It is difficult to obtain sufficient tension in the dissection plane and a good field of vision. Therefore, ESD is associated with a long procedure time and a high risk of adverse events in comparison with endoscopic mucosal resection. Traction methods have been developed to provide sufficient tension for the dissection plane and a good field of vision during the ESD procedure. However, traction direction is limited in most traction methods, resulting in insufficient effect in some cases. Although traction direction is considered important, there have been few investigations of its effect. In the first half of this review, important traction methods are discussed, including traction direction. In second half, appropriate traction methods for each organ are considered. Other important considerations for traction method, such as ability to adjust traction strength, interference between traction device and endoscope, and the need for specialized devices are also discussed.

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Efficacy of endoscopic submucosal tunnel dissection versus endoscopic submucosal dissection for superficial esophageal neoplastic lesions: a systematic review and meta-analysis

Cited by 15 publications

References 20 publications

New Applications for Submucosal Tunneling in Third Space Endoscopy

New Applications for Submucosal Tunneling in Third Space Endoscopy

Endoscopic submucosal dissection: How to be more efficient?

Advances in traction methods for endoscopic submucosal dissection: What is the best traction method and traction direction?

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