Su1112 EFFICACY AND SAFETY OF SNARE TRACTION FOR ENDOSCOPIC SUBMUCOSAL DISSECTION OF EARLY ESOPHAGEAL CARCINOMA AND PRECANCEROUS LESIONS

Abstract

Endoscopic submucosal dissection(ESD) has been rapidly gaining popularity worldwide recently due to high en bloc resection rate, minimally invasive procedure, patient rapid recovery and reduced health-care cost. However, ESD is associated with more complications, such as bleeding and perforation, especially in esophageal cases without good visualization of the dissection layer. Therefore, the efficacy and safety of snare traction for ESD of early esophageal carcinoma (EEC) or precancerous lesions was investigated. 57 EEC or precancerous patients were enrolled in the study and randomly divided into two groups . 26 cases underwent ESD with snare traction (snare group). In snare group, a snare was clamped to the oral side of the lesion after the circumferential incision and pushed in the anal direction during ESD. 31 cases underwent routine ESD without snare traction (non-snare group). The total dissection time, en bloc resection rate , average dissection area per minute, times of muscularis propria injury and incidence of perforation were statistically analyzed. ESD was successful in all 57 cases with 100% en bloc resection and there was no perforation during ESD or after ESD in all these cases. No significant difference was found between the two groups with respect to the dissection area (17.01±8.42cm2 vs 17.41±7.08cm2, P>0.1). The total dissection time of ESD was shorter in the snare group than in the non-snare group (57.10±9.65min vs 87.12±10.24min，P<0.05) . The average dissection area per minute is higher in the snare group than in the non-snare group(29.78±7.06 mm2/min vs 18.44±6.58mm2/min, P<0.05).Moreover, the muscularis propria injuries in the snare group were obviously less than the non-snare group (1.32±1.06 vs 2.50±1.12，P<0.05). Snare traction is potential for decreasing the injury of muscularis propria layer and total dissection time during ESD for esophageal cancerous lesions with easy control. It could be recommended as a safe and effective procedure for ESD of EEC and precancerous lesions.