Safety and efficacy of endoscopic submucosal dissection with gel immersion technique for superficial esophageal neoplasms

Abstract

Background and AimGel immersion (GI) endoscopy provides a good visual field in endoscopic submucosal dissection (ESD); however, its clinical outcomes are poorly understood. This study aimed to compare the treatment outcomes between esophageal gel immersion endoscopic submucosal dissection (GI‐ESD) and conventional ESD (C‐ESD) to determine the safety and efficacy of GI‐ESD.MethodsThe data of 71 consecutive patients who underwent esophageal ESD between April 2021 and March 2023 at a Japanese tertiary center were retrospectively reviewed. GI was achieved using an additional irrigation tube. The treatment outcomes between the GI‐ESD and C‐ESD groups were compared using inverse probability of treatment weighting (IPTW) to control for confounding factors.ResultsA total of 75 superficial esophageal epithelial neoplasms (41 in the C‐ESD and 34 in the GI‐ESD groups) were treated using ESD. The mean procedure time in the GI‐ESD group was significantly shorter than that in the C‐ESD group (59.2 ± 36.2 vs 85.3 ± 45.7 min, P = 0.008). After IPTW adjustment, the mean procedural times were 62.6 ± 36.6 and 82.9 ± 41.7 min in the GI‐ESD and C‐ESD groups, respectively (P = 0.037), and the incidence rate of muscle layer damage was 4.2% in the GI‐ESD group and 30.6% in the C‐ESD group (P = 0.001). In the multivariate analysis, specimen size ≥ 30 mm (odds ratio [OR]: 9.44, 95% confidence interval [CI]: 2.46–36.30, P = 0.001) was positively correlated with longer procedural time (≥ 90 min), whereas GI‐ESD (OR: 0.19, 95%CI: 0.05–0.68, P = 0.011) showed a negative association.ConclusionsEsophageal GI‐ESD may be useful in terms of safety and time efficiency. The GI technique could be an option for esophageal ESD.