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. 2022 Jan-Feb;35(1):48-55.
doi: 10.20524/aog.2021.0679. Epub 2021 Dec 6.

Usefulness of the clip-and-snare method using the pre-looping technique for endoscopic submucosal dissection of gastric neoplasia: a randomized controlled trial

Kenkei Hasatani  1 , Naohiro Yoshida  2 , Hiroyuki Aoyagi  1 , Manami Utsunomiya  1   2 , Yoshihide Naito  1 , Yutaka Matano  3 , Kei Tominaga  4 , Yohei Waseda  5 , Hisashi Doyama  2
Affiliations

Usefulness of the clip-and-snare method using the pre-looping technique for endoscopic submucosal dissection of gastric neoplasia: a randomized controlled trial

Kenkei Hasatani et al. Ann Gastroenterol. 2022 Jan-Feb.

Abstract

Background: The clip-and-snare method using the pre-looping technique (CSM-PLT) was developed as a traction method for endoscopic submucosal dissection (ESD) of gastric neoplasia. However, its usefulness has not been clearly established; thus, we aimed to assess the efficacy of CSM-PLT in gastric ESD.

Methods: In this multicenter, randomized controlled trial, patients with gastric adenoma or carcinoma with absolute or expanded indications for ESD were randomized into conventional ESD and CSM-PLT groups, using the minimization method based on operator experience, tumor location, tumor size, and excision device. The primary endpoint was ESD procedure time. Secondary endpoints were en bloc and R0 resection rates, and complications.

Results: We enrolled 402 patients between July 2017 and February 2020. After excluding patients with deviations from the protocol, we finally analyzed the data of 192 and 186 patients in the conventional and CSM-PLT groups, respectively. The procedure time was significantly shorter in the CSM-PLT group than in the conventional group (58.0 vs. 69.7 min; P=0.009). All lesions were resected en bloc. The R0 resection rate tended to be higher in the CSM-PLT group (P=0.09). No significant differences in complications were observed between the 2 groups.

Conclusions: CSM-PLT is beneficial for gastric ESD when compared with the conventional technique. CSM-PLT significantly reduced procedure times and improved R0 resection rates.

Keywords: Early gastric cancer; endoscopic submucosal dissection; traction.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
The clip-and-snare method using the pre-looping technique. (A) A transparent cap is tightened with a snare from the outside of the endoscope. (B) The clip is inserted with forceps and used to grasp the edge of the lesion. (C) The snare is loosened and moved along the forceps to the clip. (D) The clip is tightened by the snare. (E) The clip is released from the forceps, following which the appropriate traction can be obtained independently of the endoscope
Figure 2
Figure 2
Endoscopic view showing the clip-and-snare method using the pre-looping technique. (A) After marking outside the elevated lesion in the anterior wall of the lower third of the stomach. (B) After circumferential incision. (C) A clip holding the mucosal flap tightened by the snare, which had been pre-looped over the endoscope. (D) A clip released from the clip deployment device. (E) Pushing the snare: appropriate tension and good visualization were obtained for submucosal dissection in the lesser curvature side of the lesion (yellow arrowheads). (F) Pulling the snare: appropriate tension and good visualization were obtained in the greater curvature side of the lesion (red arrow heads)
Figure 3
Figure 3
Study flow diagram ESD, endoscopic submucosal dissection; CSM-PLT, clip-and-snare method using pre-looping technique
See this image and copyright information in PMC

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