Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video)

Yoshida, Masao; Takizawa, Kohei; Suzuki, Shinichi; Koike, Yoshiki; Nonaka, Satoru; Yamasaki, Yasushi; Minagawa, Takeyoshi; Sato, Chiko; Takeuchi, Chihiro; Watanabe, Ko; Kanzaki, Hiromitsu; Morimoto, Hiroyuki; Yano, Takafumi; Sudo, Kosuke; Mori, Keita; Gotoda, Takuji; Ono, Hiroyuki; Hirasawa, Dai; Oda, Ichiro; Uedo, Noriya; Fujii, Ryoji; Sumiyoshi, Tetsuya; Hirasawa, Kingo; Tsuji, Yosuke; Hikichi, Takuto; Miura, Kou; Okada, Hiroyuki; Nakamura, Hiroshi; Yano, Tomonori; Kusano, Chika; Tanabe, Satoshi; Mashimo, Yumi; Minashi, Keiko; Nakajima, Takako Eguchi; Kurokawa, Yukinori

doi:10.1016/j.gie.2017.11.031

Cited by 114 publications

(121 citation statements)

References 31 publications

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“…16 Mucosal traction with dental floss and endoclip was reported to reduce risk of perforation in a prospective randomized trial in 640 patients who received gastric ESD. 17 However, there was no difference in the operative time except for gastric ESD located in the greater curvature of the upper or middle stomach. Meanwhile, visual differentiation of the submucosal plane served as another important element for safe performance of ESD.…”

Section: E Ndoscopic Submucosal Dissection Hasmentioning

confidence: 86%

“…EndoLifter (Olympus Co. Ltd) aimed to achieve mucosal retraction by forceps attached to a transparent distal hood separately actuated by an external handle . Mucosal traction with dental floss and endoclip was reported to reduce risk of perforation in a prospective randomized trial in 640 patients who received gastric ESD . However, there was no difference in the operative time except for gastric ESD located in the greater curvature of the upper or middle stomach.…”

Section: Discussionmentioning

confidence: 99%

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How I do it: Flexible 3‐D endoscope for endoscopic submucosal dissection

Chiu

Yip

Xia

et al. 2019

Digestive Endoscopy

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Endoscopic submucosal dissection (ESD) is technically challenging as a result of a lack of depth perception. The present article investigated the 3‐D endoscope for carrying out ESD and translated the technique from bench to clinical use. In a preclinical porcine experiment, ESD using a 3‐D endoscope was compared between an experienced and a novice endoscopist. All ESD were completed without perforation. Median operative time per surface area was significantly lower for the experienced endoscopist than for the novice (197.9 s/cm2 vs 434.7 s/cm2; P = 0.05). The second part was a prospective clinical experience to evaluate use of the 3‐D endoscope for carrying out ESD. Ten patients received ESD using the 3‐D endoscope. Four patients had gastric ESD, two had duodenal ESD and four had sigmoid and rectal ESD. There were no complications, whereas ESD failed in one patient who had gastric neoplasia at anastomosis. Mean operative time was 99.4 min, and operative time per surface area resection was 391 s/cm2. The operating endoscopist did not complain of motion sickness, whereas the assistants had some dizziness upon prolonged ESD procedure. This study showed that carrying out ESD was safe and effective using a 3‐D endoscope with an excellent 3‐D view enhancing depth perception. Future study should be conducted to compare 3‐D against 2‐D endoscopes for ESD.

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Section: E Ndoscopic Submucosal Dissection Hasmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

How I do it: Flexible 3‐D endoscope for endoscopic submucosal dissection

Chiu

Yip

Xia

et al. 2019

Digestive Endoscopy

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show abstract

“…Among the 13 eligible articles of gastric ESD, we identified two RCTs, and 11 retrospective comparative studies. [22][23][24][25][26][27][28][29][30][31][32][33][34] Ten studies compared the efficacy of ESD traction devices, and three other studies investigated the efficacy of traction strategy compared with conventional ESD ( Table 2).…”

Section: Stomachmentioning

confidence: 99%

“…DFC traction pulls lesions in the direction of the cardia, providing direct, vertical traction force on the mucosal flap lifting it from the submucosa, and allowing appropriate visualization of the dissection line for problematic lesions located in the greater curvature of the upper or middle stomach. 33 Double scope method was also reported to be effective in reducing the procedural time in ESD of EGC with ulcerative scars. 26 An RCT of ESD by nonexpert endoscopists was conducted by Ahn et al 22 This trial could not demonstrate a significant difference in the ESD procedural time between transnasal scopeassisted ESD and conventional ESD.…”

Section: Stomachmentioning

confidence: 99%

Efficacy of Current Traction Techniques for Endoscopic Submucosal Dissection

Abe

Ego

et al. 2020

Gut and Liver

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This systematic review aimed to assess the efficacy of the current approach to tissue traction during the endoscopic submucosal dissection (ESD) of superficial esophageal cancer, early gastric cancer, and colorectal neoplasms. We performed a systematic electronic literature search of articles published in PubMed and selected comparative studies to investigate the treatment outcomes of tractionassisted versus conventional ESD. Using the keywords, we retrieved 381 articles, including five eligible articles on the esophagus, 13 on the stomach, and 12 on the colorectum. A total of seven randomized controlled trials and 23 retrospective studies were identified. Clip line traction and submucosal tunneling were effective in reducing the procedural time during esophageal ESD. The efficacy of traction methods in gastric ESD varied in terms of the devices and strategies used depending on the lesion location and degree of submucosal fibrosis. Several prospective and retrospective studies utilized traction devices without the need to reinsert the colonoscope. When pocket creation is included, the traction devices and methods effectively shorten the procedural time during colorectal ESD. Conclusions: Although the efficacy is dependent on the organ and tumor locations, several traction techniques have been demonstrated to be efficacious in facilitating ESD by maintaining satisfactory traction during dissection. (Gut Liver,

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“…[32][33][34] All traction devices and methods expose the submucosal layer to the stabilized endoscopic visual field, enabling easier detection and handling of vessels. Various traction devices and methods have been developed to minimize intraoperative hemorrhage.…”

Section: Hemorrhage Control During Each Step Of Gastric Esdmentioning

confidence: 99%

Hemorrhage control during gastric endoscopic submucosal dissection: Techniques using uncovered knives

2019

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Since the last decade, endoscopic submucosal dissection (ESD) has been used as the standard treatment for superficial gastrointestinal neoplasms. Trainees learning ESD frequently encounter difficulties such as vascularity, peristalsis, and fibrosis during the procedure. Because individual vascularity differs, it generally cannot be consistently avoided. Given that massive hemorrhages can prolong the procedure time and diminish treatment efficacy and that insufficient vessel handling may also increase postoperative bleeding, hemorrhage control during ESD becomes important to ensure procedure safety. This article discusses methods for controlling hemorrhage during gastric ESD. Endoscopists should have a basic understanding of the vascular architecture and the high‐density areas in blood vessels, which are susceptible to intraoperative hemorrhage. Efficient preventative coagulation should be performed in addition to mastering the techniques for hemorrhage control using hemostatic forceps. Techniques useful for preventing intraoperative hemorrhage at every step (e.g. submucosal injection, mucosal incision, and dissection) should be learned. Gaining procedural competence and learning hemorrhage control techniques not only during ESD but also in daily work would help provide safe and effective treatment.

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Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video)

Cited by 114 publications

References 31 publications

How I do it: Flexible 3‐D endoscope for endoscopic submucosal dissection

How I do it: Flexible 3‐D endoscope for endoscopic submucosal dissection

Efficacy of Current Traction Techniques for Endoscopic Submucosal Dissection

Hemorrhage control during gastric endoscopic submucosal dissection: Techniques using uncovered knives

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