Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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.
See this image and copyright information in PMC

References

    1. Isomoto H, Shikuwa S, Yamaguchi N, Fukuda E, Ikeda K, Nishiyama H, Ohnita K, Mizuta Y, Shiozawa J, Kohno S. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–336. - PubMed
    1. Pyo JH, Lee H, Min BH, Lee JH, Choi MG, Lee JH, Sohn TS, Bae JM, Kim KM, Ahn JH, Carriere KC, Kim JJ, Kim S. Long-Term Outcome of Endoscopic Resection vs. Surgery for Early Gastric Cancer: A Non-inferiority-Matched Cohort Study. Am J Gastroenterol. 2016;111:240–249. - PubMed
    1. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009;69:1228–1235. - PubMed
    1. Suzuki H, Takizawa K, Hirasawa T, Takeuchi Y, Ishido K, Hoteya S, Yano T, Tanaka S, Endo M, Nakagawa M, Toyonaga T, Doyama H, Hirasawa K, Matsuda M, Yamamoto H, Fujishiro M, Hashimoto S, Maeda Y, Oyama T, Takenaka R, Yamamoto Y, Naito Y, Michida T, Kobayashi N, Kawahara Y, Hirano M, Jin M, Hori S, Niwa Y, Hikichi T, Shimazu T, Ono H, Tanabe S, Kondo H, Iishi H, Ninomiya M Ichiro Oda for J-WEB/EGC group. Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: 'Real-world evidence' in Japan. Dig Endosc. 2019;31:30–39. - PubMed
    1. Nagata S, Jin YF, Tomoeda M, Kitamura M, Yuki M, Yoshizawa H, Kubo C, Ito Y, Uedo N, Ishihara R, Iishi H, Tomita Y. Influential factors in procedure time of endoscopic submucosal dissection for gastric cancer with fibrotic change. Dig Endosc. 2011;23:296–301. - PubMed