Splash M-knife versus Flush Knife BT in the technical outcomes of endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis

Abstract

BackgroundEndoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer. A new multi-functional ESD device was developed to achieve complete ESD with a single device. A metal plate attached to its distal sheath achieves better hemostasis during the procedure than the other needle-knife device, Flush Knife BT®, that has been conventionally used. The aim of this study was to compare the technical outcomes of ESD for early gastric cancer using the Splash M-Knife® with those using the Flush Knife BT.MethodsWe conducted a retrospective review of the case records of 149 patients with early gastric cancer treated with ESD using the needle-type ESD knives between January 2012 and August 2016 at Kitakyushu Municipal Medical Center. Lesions treated with ESD using the Splash M-knife (ESD-M) and the Flush Knife BT (ESD-F) were compared. Multivariate analyses and propensity score matching were used to compensate for the differences in age, gender, underlying disease, antithrombotic drug use, lesion location, lesion position, macroscopic type, tumor size, presence of ulceration, operator level and types of electrosurgical unit used. The primary endpoint was the requirement to use hemostatic forceps in the two groups. The secondary endpoints of procedure time, en bloc and complete resection rates, and adverse events rates were evaluated for the two groups.ResultsThere were 73 patients in the ESD-M group, and 76 patients in the ESD-F group. Propensity score matching analysis created 45 matched pairs. Adjusted comparisons between the two groups showed a significantly lower usage rate of hemostatic forceps in the ESD-M group than in the ESD-F group (6.7% vs 84.4%, p < 0.001). Treatment outcomes showed an en bloc resection rate of 100% in both groups; complete resection rate of 95.6% vs 100%, p = 0.49; median procedure time of 74.0 min vs 71.0 min, p = 0.90; post-procedure bleeding of 2.2% vs 2.2%, p = 1, in the ESD-M and ESD-F groups, respectively. There were no perforations in either group.ConclusionsESD-M appeared to reduce the usage of hemostatic forceps during ESD for early gastric cancer without increasing the adverse effects. Thus, it may contribute to a reduction in the total ESD cost.

Efficacy and timing of gastrografin administration after ileus tube insertion in patients with adhesive small bowel obstruction

“…There were confounding biases between the two study groups, as this was a nonrandomized study. Thus, propensity-score matching analysis, which has been used to compensate for confounding factors, was adopted in this study [10][11][12].…”

“…3 [2][3][4] vs. 3 [2][3] days, P = 0.51; median period of hospital admission: 12.5 [9.25-14] vs. 11 [9][10][11][12][13][14][15] days, P = 0.14). However, the median period of ileus tube intubation was significantly shorter in the NEGA group than in the EGA group (7 [5-8] vs. 5 [4][5][6][7] days, P = 0.007).…”

“…Period of hospital admission, median (days) [IQR] 11 [9][10][11][12][13][14] 12.5 [9.25-14] Adverse event, n (%) 1 (0.7) 1 (1.5) EGA, early gastrografin administration; NEGA, non-early gastrografin administration; IQR, interquartile range P-value was calculated using Fisher's exact test for categorical data. P-value was calculated using the Mann-Whitney U test for continuous data distributed abnormally.…”

Early gastrografin administration after ileus tube insertion does not improve the clinical outcomes in patients with adhesive small bowel obstruction

“…Thus, propensity-score matching analysis, which has been used to compensate for confounding factors, was adopted in this study [9][10][11]. Logistic regression of factors, including background characteristics, and propensity score were calculated.…”

“…In the NEGA group, 5.9% (5/85) of patients were successfully treated without gastrografin administration. The median period until the first stool and median period of hospital admission were not significantly different between the EGA and NEGA groups (median period until the first stool: 3 [IQR, 2-4] vs. 3 [IQR, 2-3] days, P = 0.51; median period of hospital admission: 12.5 [IQR, 9.25-14] vs. 11 [IQR, [9][10][11][12][13][14][15] days, P = 0.14). However, the median period of ileus tube intubation was significantly shorter in the NEGA group than in the EGA group (7 [IQR, [5][6][7][8] vs. 5 [IQR, 4-7] days, P = 0.007).…”