Endoscopic Submucosal Tunnel Dissection Group Research Articles

Efficacy and safety of modified endoscopic submucosal tunnel dissection for superficial esophageal circumferential lesions.

To evaluate the efficacy and safety of intra-tunnel dissection using hemostatic forceps and needle-type device for patients with esophageal circumferential lesions (ECLs). Patients with ECLs were enrolled in the study and underwent endoscopic submucosal tunnel dissection (ESTD) or hemostatic forceps-based ESTD (ESFTD). All patients were divided into three subgroups according to longitudinal length of the lesions (LLLs): >8 cm, 4-8 cm and < 4 cm. The clinical data such as gender, age, length of lesions and operating time were collected. A total of 152 patients were included in this study and comprised 80 cases of ESFTD and 72 cases of ESTD. The procedure time was markedly shorter in the ESFTD group than in the ESTD group (P < 0.001). Moreover, ESFTD significantly increased the rate of complete resection and reduced specimen injury in LLLs >8 cm and 4-8 cm subgroup compared with ESTD (P < 0.001), but not in <4 cm subgroup (P > 0.05). The perforation and infection rate were similar in ESFTD and ESTD group (P > 0.05). However, ESFTD effectively decreased the muscular injury rate' the duration of chest pain and the time from endoscopic surgery to first occurrence of esophageal stenosis compared with ESTD group (P < 0.01). ESFTD has better efficacy and safety than ESTD in the treatment of ECLs, especially for large lesions. ESFTD could be recommended for patients with ECLs.

Comparison between endoscopic submucosal tunnel dissection and endoscopic submucosal dissection for superficial neoplasia at esophagogastric junction: a case-matched controlled study of a single center from China.

So far, little evidence is available for the comprehensive comparison of endoscopic submucosal tunnel dissection (ESTD) with endoscopic submucosal dissection (ESD) for the treatment of superficial neoplasia at esophagogastric junction (EGJ). EGJ superficial neoplasia patients with ESTD treatment between January, 2021 and August, 2020 were retrospectively reviewed and individually matched at 1:1 ratio with those with ESD treatment according to lesion size, specimen area and lesion location, forming ESTD and ESD group, respectively. A sample size of 17 patients was collected for each group. Treatment outcomes including resection time, specimen area, and resection speed as well as occurrence of complications were evaluated. Compared with ESD group, ESTD group got shorter resection time (111.00 ± 11.70min for ESD group vs. 71.59 ± 6.18min for ESTD group, p = 0.008) and faster section speed (0.23 ± 0.03 cm2/min for ESD group vs. 0.37 ± 0.06 cm2/min for ESTD group, p = 0.012). No complication was found to occur in ESTD group, while 1 patient with MP damage and 1 with delayed bleeding was found in ESD group. For the treatment of EGJ superficial neoplasia, ESTD is a safer and more effective and reliable endoscopic technique compared with ESD.

Efficacy and safety of endoscopic submucosal tunnel dissection for rectal laterally spreading tumors.

Evidence that comprehensively compares the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) with endoscopic submucosal dissection (ESD) for rectal laterally spreading tumors (LSTs) is limited. Between January 2009 and June 2018, 143 rectal LSTs in 143 patients who had undergone either ESD (n = 84) or ESTD (n = 59) were included in the study. One-to-one propensity score matching (PSM) was performed, and 50 pairs were selected. The data on patient demographics, treatment information, pathology reports, adverse events and follow-up were collected. Before PSM, the median specimen area was significantly larger in the ESTD group than in the ESD group (12.56 cm2 vs. 6.32 cm2, respectively; p < 0.001). The median dissection speed was significantly higher in the ESTD group than in the ESD group (24.53 mm2/min vs. 15.16 mm2/min, respectively; p < 0.001). After PSM, the median dissection speed was significantly higher in the ESTD group than in the ESD group (23.80 mm2/min vs. 17.12 mm2/min, respectively; p < 0.001). In multiple linear regression analysis, significant factors related to a higher dissection speed were the treatment method of ESTD (p < 0.001) and larger specimen area (p < 0.001). ESTD appears to be a safe and effective method to treat rectal LSTs. Compared with ESD, ESTD appears to achieve a higher dissection speed for rectal LSTs.

Efficacy and safety of endoscopic submucosal tunnel dissection vs endoscopic submucosal dissection for early superficial upper gastrointestinal precancerous lesions and tumors: A meta-analysis.

Endoscopic submucosal tunnel dissection (ESTD) is a new treatment for superficial upper gastrointestinal precancerous lesions and tumors. However, its safety and efficacy for treating these lesions is still uncertain. This meta-analysis aimed to compare the efficacy and safety of ESTD with those of endoscopic submucosal dissection (ESD) in treating early superficial upper gastrointestinal precancerous lesions and tumors. Electronic databases, including EMBASE, PubMed, Cochrane Library and the Web of Science, were systematically searched for articles published up to 1 April 2020. The primary outcomes were complete and en bloc resection rates of the lesions. The secondary outcomes included operation time, speed of dissection, complication and recurrence rates. The Newcastle-Ottawa quality assessment scale was used to evaluate the quality of the studies. Seven studies were included in the final meta-analysis. The complete and en bloc resection rates of early superficial esophageal lesions as well as the en bloc resection rate of early superficial gastric lesions were similar between the ESTD and ESD groups. Compared with the ESD group, the ESTD group had a higher en bloc resection rate for early superficial gastric lesions. A faster dissection speed was observed in both superficial esophageal and gastric lesions. In gastric lesions, the operation time of the ESTD group was shorter than that of the ESD group, while it did not differ for esophageal lesions. There were no obvious differences in bleeding and perforation rates between the groups. As an endoscopic technique for treating early superficial upper gastrointestinal lesions, ESTD is as safe as and more effective than ESD, especially for gastric lesions.

Efficacy of endoscopic submucosal tunnel dissection versus endoscopic submucosal dissection for superficial esophageal neoplastic lesions: a systematic review and meta-analysis.

To evaluate the effectiveness of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) in superficial esophageal neoplastic lesions (SENL). A comprehensive search for studies investigating the efficacy of ESTD and ESD for SENL was conducted to search for relevant studies through PubMed, Web of Science, Cochrane Library, SinoMed, CNKI, and Wanfang.Weighted pooled rates were calculated for en bloc resection rate, R0 resection rate, operation time, dissection area, dissection speed, and adverse events. The 95% confidence intervals (95%CI) for effect size were used to calculate the pooled value using the fixed- or random-effects model. A total of seventeen studies with 1161 patients were identified and included in the meta-analysis.The pooled analysis showed that ESTD had significantly higher en bloc resection (OR 3.98; 95% CI 1.74 to 9.12; p = 0.001) and R0 resection rates (OR 2.29; 95% CI 1.54 to 3.46; p < 0.001) than ESD.The operation time in the ESTD group was shorter than that in the ESD group (SMD = -0.57; 95% CI -0.95 to -0.19; p = 0.003). The dissection area of the ESTD group was larger than that in the ESD group (SMD = 0.49; 95% CI 0.16 to 0.83; p = 0.004), and the dissection speed is faster than that in the ESD group (SMD = 1.52; 95%CI 1.09 to 0.83; p < 0.001). There were no significant differences in esophageal stenosis (p = 0.94) between the two techniques. However, ESTD was superior to ESD in other adverse events (p < 0.05). ESTD has a significant advantage over ESD in the treatment of SENL. ESTD has significantly higher en bloc and R0 resection rates and reduced adverse events.

Mo1670 EFFICACY AND SAFETY OF ESTD AND ESD IN THE TREATMENT OF LARGE AREA RECTAL LATERALLY SPREADING TUMORS

This study aims to compare the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) in the treatment of large area rectal laterally spreading tumors (LST). The clinical data, operation procedures and pathology of rectal LST treated with ESD and ESTD from August 2011 to February 2019 in the Center of Digestive Endoscopy, West China Hospital of Sichuan University were retrospectively analyzed. The rates of en bloc, curative resection, complications and recurrence of tumors were compared and analyzed, then we evaluated the safety and effectiveness of ESD and ESTD in the treatment of large area LSTs. There were 122 patients with rectal LST in ESD and ESTD groups. The lesion area was 12.6±14.1 cm2, 24.5±19.9 cm2, respectively, p < 0.001.;the en bloc resection rate was 88.3% ,97.8%,respectively,p=0.066; the dissection speed was 23.3±18.3 mm2/min, 27.1±13.2 mm2/min, respectively, p=0.239; the curative resection rate was 98.7%, 86.7%, respectively,p=0.006; There were 7 cases of non-curative resection in the two groups after operation, of which 6 cases underwent additional surgery. Postoperative complications were mainly fever and hematochezia without endoscopic intervention, with fewer serious complications. The overall canceration rate of LST was 17.3%. The follow-up time of the two groups was 16.4 ±16.0 months and 23.20±16.3 months, respectively. Only one case recurred in ESD group. In the analysis of large area lesions(>3cm), there were 90 patients with large area LST, 50 patients in ESD group and 40 patients in ESTD group .The lesion areas of the two groups was 17.4±15.5 cm2 , 26.0±19.8cm2, respectively, p=0.025;the en bloc resection rate was 85%, 97.5%, respectively, p=0.034; the dissection speed was 28.4±20.3 mm2/min, 28.3 ±12.9 mm2/min, respectively, p=0.991; the curative resection rate was 92.5%, 100%, respectively, p=0.084. Both ESD and ESTD can safely and effectively resect rectal LST, which was not affected by the size of lesions. There was no significant difference in the dissection speed and the curative resection rate. When large area LST was resected, the rate of en bloc resection of ESTD was higher than that of ESD.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Clinical outcomes of endoscopic submucosal tunnel dissection compared with conventional endoscopic submucosal dissection for superficial esophageal cancer: a systematic review and meta-analysis.

Endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal cancer. However, it has limitations in case of large superficial esophageal squamous cell neoplasms (SESCNs), in which submucosal injection cannot attain satisfactory lifting effects. Thus, endoscopic submucosal tunnel dissection (ESTD) was introduced as a new treatment for SESCNs presenting satisfying results. Many studies have tried to verify the efficacy of ESTD, yet no meta-analysis has been published until now. We searched the databases of PubMed, Cochrane Library, Web of Science, SinoMed, Wanfang, and CNKI dating up to February 1, 2019. Studies comparing the clinical outcomes of ESTD and ESD for superficial esophageal cancers were enrolled. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of these studies. Eight articles were included that involved a total of 625 superficial esophageal cancer patients. Our analysis revealed that ESTD is superior to ESD as it has higher en bloc resection rate, shorter operation time, and lower recurrence rate 1 year after operation. The R0 resection rate and postoperative adverse event rate of ESTD group is comparable with ESD group. Our study implicates that ESTD is a potentially superior treatment to ESD for superficial esophageal cancer.

Comparison of Short-Term Efficacy Between Endoscopic Submucosal Tunnel Dissection and Endoscopic Submucosal Dissection in Treatment of Wide Esophageal Squamous Cell Carcinoma of Early Stage.

The goal of this study was to compare the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) with endoscopic submucosal dissection (ESD) for the removal of early-stage esophageal squamous cancer wider than or equal to one half the circumference of the esophagus. Although ESD has been successfully applied for resection of early-stage esophageal cancer, there are still technical challenges and postoperative stenosis when it is applied to treat large lesions. A total of 40 patients with early-stage esophageal cancer wider than or equal to one half its circumference were enrolled in this study and randomly assigned to an ESTD or ESD group for treatment of esophageal superficial squamous cell carcinoma. All of the patients received oral steroids after endoscopic dissection. We then compared the 2 groups in terms of average operating time, dissection speed, en bloc resection rate, R0 resection rate, and complications during a 1-year follow-up period. The dissection speed in the ESTD group was significantly faster than that in the ESD group (P=0.047). There were no significant differences in operating time, en bloc resection rates, or R0 resection rates between the ESTD and ESD group (P=0.319, 1.000, 1.000, respectively). There were also no significant differences in perforation, bleeding, or stenosis rates between the ESTD and ESD group (P=1.000, 0.748, 1.000, respectively). Both ESTD and ESD are safe and effective therapies for early-stage esophageal cancer wider than or equal to one half the esophageal circumference. The dissection speed of ESTD is faster than that of ESD.

Endoscopic submucosal tunnel dissection for treatment of large gastric angle superficial neoplasms: a multicenter retrospective study

Objective To evaluate the clinical value of endoscopic submucosal tunnel dissection (ESTD) for treatment of large gastric angle superficial neoplasms. Methods A retrospective analysis was performed on data of 87 patients with superfical neoplasms in gastric angle, including 32 cases undergoing ESTD and 55 cases undergoing endoscopic submucosal dissection (ESD) in 6 institutions between July 2014 and July 2016. The dissection time, dissection speed, en bloc resection rate, curative resection rate, adverse events, and prognosis were compared between the two groups. Results The ESTD group showed a shorter dissection time (87.3±32.6 min VS 136.7±64.5 min, P<0.01), a higher dissection speed (0.18±0.07 cm2/min VS 0.08±0.05 cm2/min, P<0.01), a higher en bloc resection rate[100% (32/32) VS 87.3% (48/55), P=0.035], and a higher curative resection rate[100% (32/32) VS 85.5% (47/55), P=0.024] compared with the ESD group. The intraoperative bleeding rate[59.4% (19/32) VS 100.0% (55/55), P<0.01] and muscular injury rate[0 (0/32) VS 14.5% (8/55), P=0.024] were lower in the ESTD group than those of the ESD group. There was no statistical difference on recurrence rate between the two groups[0 (0/32) VS 1.9% (1/54), P=0.443]. Conclusion ESTD has a higher dissection speed and greater security on treatment of large gastric angle superficial neoplasms, and is worthy to be generalized. Key words: Stomach neoplasms; Gastric angle; Endoscopic submucosal tunnel dissection; Endoscopic submucosal dissection; Efficacy; Safety

A multicenter retrospective study of endoscopic submucosal tunnel dissection for large lesser gastric curvature superficial neoplasms.

Endoscopic submucosal tunnel dissection (ESTD) has been used for dissection of esophageal and gastric lesions. However, outcomes of ESTD for large lesions in the lesser gastric curvature had not been acknowledged because previous reports had the limitations of being single-center studies. We aimed to clarify the outcomes of ESTD for large lesser gastric curvature superficial neoplasms and provide our experience to accelerate its application. Between July 2014 and July 2016, 87 patients with early cancer in the lesser gastric curvature treated at six Chinese institutions were enrolled. Our primary outcome was dissection speed. Moreover, both efficacy and safety clinical data were collected and analyzed retrospectively. All of the 87 patients were found to successfully undergo ESTD or ESD. Of these, 32 underwent ESTD and 55 underwent endoscopic submucosal dissection (ESD). The ESTD group had a higher dissection speed (18.0mm2/min vs. 7.8mm2/min, p < 0.01) and was associated with higher en bloc resection rate (100% vs. 87.3%, p = 0.035) and curative resection rate (100% vs. 85.5%, p = 0.024) compared with the ESD group. No perforation or muscular injury occurred in the ESTD group and its intraprocedural bleeding rate was lower (59.4% vs. 100%, p < 0.01) than that of the ESD group. In this multicenter retrospective study, outcomes of ESTD were excellent with a higher dissection speed and radical curative rate compared with ESD.

Comparison of two porcine benign esophageal stricture models using radiofrequency ablation and endoscopic submucosal tunnel dissection

Large-animal benign esophageal stricture (BES) models are needed for the development of new endoscopic therapies and related devices. This study was undertaken to develop and compare swine BES models produced by radiofrequency ablation (RFA) or endoscopic submucosal tunnel dissection (ESTD). RFA and ESTD were each performed on three pigs. Follow-up endoscopy and esophagography were performed immediately after the procedures and then 2, 3, and 4 weeks later. Four weeks after the procedures, all animals were sacrificed, and gross and histologic examinations were performed. BES was successfully achieved in both the RFA and ESTD groups, and all animals survived without any serious adverse events during the 4-week follow-up period. Mean procedural times were 9.3 min for RFA and 89.3 min for ESTD. ESTD caused long segment strictures whose average length was 4.5 cm, whereas RFA produced short strictures whose average length was 1.4 cm. BES began to form 2 weeks after both procedures. Degrees of strictures were similar at 3 and 4 weeks in the ESTD group; however, it started deteriorating over time in the RFA group. Histologic examinations showed that ESTD caused inflammation and fibrosis in the submucosal layer, whereas RFA induced extensive inflammation in the submucosal and muscularis propria layers. BES was successfully achieved using RFA or ESTD in swine without serious complications. The methods have different characteristics; therefore, researchers should choose the method more appropriate for their purposes.

Endoscopic submucosal tunnel dissection using a novel bracing basket: An animal feasibility study

The aim of this study was to evaluate the feasibility of a novel bracing basket for Endoscopic submucosal tunnel dissection (ESTD), which was developed for improved effectiveness and ease of use. This was a prospective randomized, comparative, experimental animal study carried out at a single center. The primary aim was to evaluate the efficacy of ESTD with a novel bracing basket, compared with conventional ESTD. The secondary aims were to assess the quality control of the procedures and adverse events. Twenty procedures (6 esophageal and 14 gastric) were performed in four pigs. All resections were completed as en bloc resections. The technical success rate was 100% for both techniques (bracing basket-assisted ESTD vs. conventional ESTD). The procedure times were similar, but the cutting speed was quicker with bracing basket-assisted ESTD in gastric (antrum:23.3 ± 2.2 mm2/min vs. 15.2 ± 3.2 mm2/min, body: 26.1 ± 1.3 mm2/min vs. 18.4 ± 2.0 mm2/min, p < 0.05). There was one bleeding in the bracing basket-assisted ESTD group and one perforation in the conventional ESTD group. Compared with conventional ESTD, the use of this basket has potential advantages. Comparison studies with larger gastric or colorectal lesions treated with conventional ESTD are needed.

Endoscopic Submucosal Tunnel Dissection for Large Gastric Neoplastic Lesions: A Case-Matched Controlled Study.

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.