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. 2021 Mar 15;13(3):174-184.
doi: 10.4251/wjgo.v13.i3.174.

Efficacy and safety of grasping forceps-assisted endoscopic resection for gastric neoplasms: A multi-centre retrospective study

Ryoji Ichijima  1 , Sho Suzuki  2 , Mitsuru Esaki  2 , Toshiki Horii  2 , Chika Kusano  2 , Hisatomo Ikehara  2 , Takuji Gotoda  2
Affiliations

Efficacy and safety of grasping forceps-assisted endoscopic resection for gastric neoplasms: A multi-centre retrospective study

Ryoji Ichijima et al. World J Gastrointest Oncol. .

Abstract

Background: Endoscopic submucosal dissection (ESD) is widely accepted for early gastric cancer (EGC) without lymph node metastasis, although ESD is challenging, even for small lesions, in the greater curvature (GC) of the upper (U) and middle (M) thirds of the stomach. Grasping forceps-assisted endoscopic resection (GF-ER) is a type of endoscopic mucosal resection that is performed via a double-channel endoscope.

Aim: To investigate the safety and efficacy of GF-ER vs ESD in the GC of the stomach's U and M regions.

Methods: We retrospectively reviewed the medical records of 506 patients who underwent ER of 522 EGC lesions in the stomach's U and M regions in three institutions between January 2016 and May 2020. Nine lesions from eight patients who underwent GF-ER for EGC (the GF-ER group) were compared to 63 lesions from 63 patients who underwent ESD (the ESD group). We also performed a subgroup analysis of small lesions (≤ 10 mm) in 6 patients (7 lesions) from the GF-ER group and 20 patients (20 lesions) from the ESD group.

Results: There were no statistically significant differences between the GF-ER and ESD groups in the en bloc resection rates (100% vs 100%) and the R0 resection rates (100% vs 98.4%). The median procedure time in the GF-ER group was shorter than that in the ESD group (4.0 min vs 55.0 min, P < 0.01). There were no adverse events in the GF-ER group, although five perforations (8.0%) and 1 case of postoperative bleeding (1.6%) were observed in the ESD group. When we only considered lesions that were ≤ 10 mm, the median procedure time in the GF-ER group was still shorter than that in the ESD group (4.0 min vs 35.0 min, P < 0.01). There were no adverse events in the GF-ER group, although 1 case of perforation (1.6%) were observed in the ESD group.

Conclusion: These findings suggest that GF-ER may be an effective therapeutic option for small lesions in the GC of the stomach's U and M regions.

Keywords: Endoscopic mucosal resection; Endoscopic resection; Endoscopic submucosal dissection; Gastric cancer; Grasping forceps-assisted endoscopic resection.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict-of-interests.

Figures

Figure 1
Figure 1
Study flowchart. ESD: Endoscopic submucosal dissection; GF-ER: Grasping forceps-assisted endoscopic resection; M: Middle; U: Upper.
Figure 2
Figure 2
The grasping forceps-assisted endoscopic resection procedure. A: Normal saline solution was injected into the submucosa around the lesion; B: A snare and grasping snare were both deployed through one of the scope’s two channels; C: The grasping snare was used to firmly grasp the elevated mucosa; D: The snare encircled the grasped mucosa; E: We ensured that the entire lesion was inside the snare, and then the resection was performed; F: After the resection, the mucosal defect was checked for residual tumour.
Figure 3
Figure 3
Location mapping for the 9 cases of early gastric cancer treated using grasping forceps-assisted endoscopic resection. The yellow circles show the locations of the lesions that were treated using grasping forceps-assisted endoscopic resection. L: Lower; M: Middle; U: Upper.
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