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. 2018 Mar 6:2018:1419369.
doi: 10.1155/2018/1419369. eCollection 2018.

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

Xiuxue Feng  1 , Enqiang Linghu  1 , Ningli Chai  1 , Zhongsheng Lu  1 , Xiangdong Wang  1 , Ping Tang  1 , Jiangyun Meng  1 , Hong Du  1 , Hongbin Wang  1
Affiliations

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

Xiuxue Feng et al. Gastroenterol Res Pract. .

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.

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Figures

Figure 1
Figure 1
ESD procedure. (a) Lesion under light endoscopy. (b) Marking the margin. (c) Circumferential incision. (d) Submucosal dissection. (e) Hemostasis with hot biopsy forceps. (f) The artificial ulcer after complete removal of the lesion. (g) The muscularis propria damage. (h) The damage was closed with clips to prevent perforation.
Figure 2
Figure 2
ESTD procedure. (a) Lesion under light endoscopy. (b) Marking the margin followed by submucosal injection. (c) Anal incision. (d) Oral incision. (e) One tunnel was established from oral to anal incision through submucosal dissection. (f) Bilateral resection. (g) Visible vessels were preventatively coagulated with APC. (h) The artificial ulcer after en bloc resection of the lesion.
Figure 3
Figure 3
Graph representing the changes of the paired cases. (a) The specimen areas are similar between the two groups. (b) Compared with ESD, ESTD presents faster resection speed in all pairs.
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