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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.
Highlights
The widespread use of gastroscopy and equipment innovations in endoscopic technology has increased the detection rate of superficial gastric lesions (SGLs) [1, 2]
No complications were observed in the endoscopic submucosal tunnel dissection (ESTD) group, but one case with muscularis propria (MP) damage was found in the Endoscopic submucosal dissection (ESD) group and the damage was closed with two clips
After comparison between the two groups, ESTD was demonstrated to be faster for large SGLs than ESD
Summary
The widespread use of gastroscopy and equipment innovations in endoscopic technology has increased the detection rate of superficial gastric lesions (SGLs) [1, 2]. As the acceptance of expanded indications of endoscopic resection, endoscopists have to face an increasing number of patients with large SGLs. Endoscopic submucosal dissection (ESD) has been established as one standard treatment for SGLs, providing a higher en bloc resection rate and more accurate pathological evaluation than endoscopic mucosal resection (EMR) [1, 2, 4]. The main influencing factor in ESD operation for large lesions is poor visualization of the submucosal layer due to contraction or curling of the resected mucosa [5,6,7,8,9,10,11,12,13,14,15,16,17]. How to lift the submucosal layer and dissect large lesions under direct vision becomes a very challenging problem
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