Endoscopic Submucosal Tunnel Dissection for Lesser Gastric Curvature Superficial Neoplasms: 2017 Presidential Poster Award

Abstract

Introduction: Endoscopic submucosal dissection (ESD) has been widely used for resection of gastrointestinal neoplastic lesions, but there are still technical challenges in treating large ones especially located in lesser gastric curvature. In the tunnel technique, incisions at the lower and upper lesion edges are joined by a submucosal tunnel and then lateral incisions are made. The mucosa is thereby easily separated from the muscular layer. We report our experience of endoscopic submucosal tunnel dissection (ESTD) in lesser gastric curvature. Methods: 47 patients with lesser curvature superficial neoplasms undergoing endoscopic resection were analyzed retrospectively. 26 patients underwent ESTD and 21 received ESD. Operation time, security, En bloc resection rate and complications were compared between the two groups. The major difference between ESTD and ESD is that, instead of pre-cutting circumferential mucosal, a submucosal tunnel was created by submucosal dissection from the oral incision to the anal incision. Bilateral resection was then performed to remove the lesion completely. Results: The differences between the two groups in the age of the patients and the diameter of the lesions had no statistically significant (P > 0.05). En bloc resection rate was 100% in the study group and 90.5% in the control group (19/21), and the difference was statistically significant (P < 0.05). The average operation time was 46 minutes (36˜59 minutes), the control group was77 minutes (48˜110 minutes), the difference was statistically significant (P < 0.05). The intraoperative bleeding rate of the study group was 57.7% (15/26), the control group was 100%, the difference was statistically significant (P < 0.05). The incidence of perforation was 0% in the study group and 9.5% in the control group (2/21), and the difference was statistically significant (P < 0.05). There was 1 case of delayed bleeding after operation in the two groups, there were no postoperative perforation, and the difference was not statistically significant (P > 0.05). There were no recurrence and metastasis in the two groups after the operation. Conclusion: In contrast to ESD, ESTD shows larger working space, shorter operating time, lower perforation and hemorrhage rate. Patients can recover quicklier so that the length of hospital stay can be decreased. The application prospect of ESTD is promising, especially for those tumors with lager size, and further investigation should be conducted.Figure: The lesion located in lesser gastric curvature.Figure: A submucosal tunnel was created by submucosal dissection from the oral incision to the anal incision.