Endoscopic Submucosal Tunnel Dissection for Large Gastric Neoplastic Lesions: A Case-Matched Controlled Study

Abstract

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.

Efficacy and safety of endoscopic submucosal tunnel dissection vs endoscopic submucosal dissection for early superficial upper gastrointestinal precancerous lesions and tumors: A meta‐analysis

“…A total of 22 studies were further excluded for the following reasons: (a) insufficient data; (b) duplicates; (c) irrelevant to the review topic; (d) studies on animal models; and (e) case reports and review articles. Seven studies 7‐13 were finally inclued for this meta‐analysis.…”

“…As shown in Table 2, two studies that reported recurrence, 9,12 including one in the ESTD group and two in the ESD group. One recurrence of poorly‐to‐moderately differentiated intramucosal adenocarcinoma was found in the ESTD group at 15 months of follow‐up.…”

Safety and Efficacy of Nonanesthesiologist-Administrated Propofol during Endoscopic Submucosal Dissection of Gastric Epithelial Tumors

“…As the population ages, endoscopists are increasingly faced with challenges associated with treating older patients with comorbidities safely and effectively [16, 17]. Currently, ESD is widespread as a minimally invasive endoscopic treatment for early gastrointestinal cancer and is also actively applied to large lesions and lesions with an ulcer scar that cannot be resected using conventional endoscopic mucosal resection (EMR) [18–20]. ESD requires precise and complicated maneuvers and, thus, results in longer operating times and increases the risks of undesirable side effects compared with EMR.…”

Endoscopic submucosal tunnel dissection with ring-thread countertraction for a large gastric tumor with extensive severe fibrosis

“…The effectiveness of endoscopic submucosal tunnel dissection (ESTD) has been reported as a good method for providing traction. 1,2 However, ESTD alone did not provide enough traction in this case because of the lesion size and extensive severe fibrosis. In such a situation, combined use of traction by using ring-thread counter traction was effective (Fig.…”