358 The Efficacy of the “Clip With the Line” Method During Esophageal Endoscopic Submucosal Dissection Against Superficial Esophageal Cancer -a Retrospective Study-

Abstract

358 The Efficacy of the “Clip With the Line”Method During Esophageal Endoscopic Submucosal Dissection Against Superficial Esophageal Cancer -a Retrospective StudyYoshiaki Shoji*, Tai Omori, Hirofumi Kawakubo, Hiroya Takeuchi, Tsunehiro Takahashi, Norihito Wada, Rieko Nakamura, Yoshiro Saikawa, Kazuo Koyanagi, Yuko Kitagawa Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Center of Diagnostic and Therapeutic Endoscopy, Keio university School of Medicine, Tokyo, Japan; Department of Surgery, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan Introduction: Esophageal Endoscopic Submucosal Dissection (Esophageal ESD) against Superficial Esophageal Cancer requires an advanced technique because of the thinness of the esophageal wall and the movement by aspiration and cardiac beat. To be free of complication and to shorten the Duration of its procedure is an important point. Oyama et al. has reported a positive outcome by making a counter traction using a Clip with the Line method. (Oyama T. et al. Counter traction makes endoscopic submucosal dissection easier: Clin Endosc 2012 Nov; 45 (4) 375-8). Objective: To verify the efficacy and safety of Clip with the Line method. MethodsFrom January 2009 to March 2013, 199 patients underwent Esophageal ESD against Superficial Esophageal Cancer in Keio University Hospital, Tokyo, Japan. We reviewed the Duration of the procedure and the complication in each using Clip with the line group (using group) and the control group retrospectively. The Duration of the procedure was sorted by the location and the extent of the lesion. We defined the duration of the Esophageal ESD as the time between circumferential dissection and extirpation. We limited the operator to 2 senior physicians who have carried out more than 100 cases of Esophageal ESD. Results100 patients underwent Esophageal ESD against Superficial Esophageal Cancer using Clip with the Line, and 99 patients without. The minimum time maximum time / median time / mean time of the duration in each group was using group; 6min 102min / 17.5min / 26.5min, control group; 7min 149min / 28.0min / 37.5 min, significantly shorter in the Clip with the Line using group (p!0.001). There were no appreciable complications between both groups. Sorting by the location and the size, the duration of the using group was significantly shorter in the anterior wall / less than 50mm in diameter, and in the right, left, posterior wall / less than 70mm in diameter (p!0.05). Clip with the Line appears to be a safe devise, and makes a good visibility in submucosal dissection, regardless of the tumor’s location or extent. Conclusion: Use of the Clip with the line method significantly shortened the duration of the Esophageal ESD against Superficial Esophageal Cancer compared to the control group. It showed a marked time crunch in the lesion of the left wall, in which we cannot use the gravitational effect.Clip with the line is a safe, cheap, easy to use device, which shorten the duration and prevent complications of Esophageal ESD. We should consider it’s use positively regardless of the location and size of the lesion.