Effect of Water-Jet Function On Endoscopic Submucosal Dissection for Early Gastric Cancer: A Prospective Randomized Controlled Trial

Abstract

Background: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), yields higher complete resection rates than conventional endoscopic mucosal resection methods. However, one of the problems with ESD is that it prolongs procedure time considerably. Objective: To investigate whether an endoscope with water-jet function (J-scope) could shorten ESD procedure time. Design: A prospective randomized controlled trial. Setting: A referral cancer center. Patients: A total of 75 consecutive patients with 82 EGCs that fulfilled the treatment guideline of the Japanese Gastric Cancer Society i.e. clinically mucosal differentiated type adenocarcinoma less than 2 cm without ulcer or scar. Interventions: Three endoscopists participated in the study as operators. After stratification by the operator and location of the tumor, the lesions were randomly assigned to treatment groups, and were treated by the J-scope or conventional videoendoscopes. Main outcome measurements: Total procedure time as a primary endpoint, and time for mucosal incision, time for submucosal dissection and the operators' preference at the end of the study as secondary endpoints. Results: There were no differences in operators who performed the ESD, mean resected specimen size, location, histology, type and mean size of the tumors between the two groups. The mean (±SD) total procedure time with the J-scope group: 62 ± 35 min was not significantly different than that with the conventional videoendoscope group: 69 ± 32 min, (p = 0.362). There was also no significant difference between the two groups in mean mucosal incision time and submucosal dissection time. Subclass analysis did show that the mean (±SD) total procedure time for performing ESD on lesions in the gastric body (n = 40) was significantly shorter in the J-scope group: 63 ± 33 min compared to the conventional videoendoscope group: 84 ± 34 (p = 0.044). Subjectively, at the conclusion of the study all of the endoscopists strongly preferred the J-scope because it facilitated hemostastis, which is the most stressful part of ESD procedures. Limitation: Wide variation of the total procedure time. Conclusions: The J-scope with water jet function did not shorten procedure time for ESD compared to conventional videoendoscopes, although it was preferred by all operators because it facilitates hemostasis.