Effectiveness of clip-and-snare method using pre-looping technique for gastric endoscopic submucosal dissection

Yoshida, Naohiro; Doyama, Hisashi; Ota, Ryosuke; Takeda, Yasuhito; Nakanishi, Hiroyuki; Tominaga, Kei; Tsuji, Shigetsugu; Takemura, Kenichi

doi:10.4253/wjge.v8.i12.451

Cited by 21 publications

(24 citation statements)

References 18 publications

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“…The double scope method [19] requires two endoscopists. The clip-and-snare method [20] has relatively strong interference with endoscope and traction direction is limited to the two ways. The internal traction method [21][22][23],SLC-ESD is classified in this category, has a relatively complicated procedure; thus, its use is not standardized in gastric ESD.…”

Section: Discussionmentioning

confidence: 99%

Internal traction method using a spring-and-loop with clip (S–O clip) allows countertraction in gastric endoscopic submucosal dissection

Nagata

2020

Surg Endosc

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Background Insufficient countertraction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Internal traction method using a spring-and-loop with clip (SLC) allows sufficient traction in any direction and good field of vision. However, the attachment procedure is difficult and interference with the endoscope can occur in the retroflexed endoscopic position. We have developed a new use of SLC that simplifies the attachment procedure, eliminating interference with the endoscope. The aim of this study was to investigate the efficacy of SLC for gastric ESD. Methods We retrospectively recruited 140 patients with gastric neoplasms who underwent ESD between November 2015 and October 2018 at our department. Among them, 51 patients treated using SLC-assisted ESD (SLC-ESD) and 89 patients treated using conventional ESD (C-ESD) were compared. Propensity score matching was performed to compensate for the differences in age, sex, lesion location, lesion position, specimen size, and ulcer findings. The primary outcome was ESD procedure time. Results Propensity score matching generated 51 matched pairs. The procedure time in the SLC-ESD group was significantly shorter than that in the C-ESD group (median [interquartile], 40.0 [27.0-81.5] minutes versus 69.0 [46.5-113.5] minutes, P = 0.008). The mean SLC attachment time was 2.08 min. There were no significant differences in complete en bloc resection rate between SLC-ESD and C-ESD groups (100% versus 96.1%, P = 0.495). There were not perforation cases in either group. Conclusions SLC may offer an efficient method for gastric ESD, with a short attachment procedure time.

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Section: Discussionmentioning

confidence: 99%

Internal traction method using a spring-and-loop with clip (S–O clip) allows countertraction in gastric endoscopic submucosal dissection

Nagata

2020

Surg Endosc

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“…There is some evidence for its use in gastric lesions, and can be used in the colon with a balloon overtube. 88,89 A further technique that allows traction in any direction is the double endoscope method, whereby a second smaller endoscope is inserted alongside the main scope with grasping forceps. However, this clearly requires a lot of space, and so far is useful only in gastric and rectal lesions.…”

Section: Traction Methodsmentioning

confidence: 99%

“…There is some evidence for its use in gastric lesions, and can be used in the colon with a balloon overtube. 88 , 89 …”

Section: Traction Methodsmentioning

confidence: 99%

Endoscopic submucosal dissection: an update on tools and accessories

Harlow

Sivananthan

Ayaru

et al. 2020

Clin Med Insights Gastroenterol

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Endoscopic submucosal dissection (ESD) is a minimally invasive therapeutic procedure to remove larger polyps or early non-metastatic lesions. It has long been used in Asia, but is now fast growing in popularity in the West. There are multiple challenges faced by ESD practitioners. While the practice of ESD in gastric lesions is relatively well established, the oesophagus with its narrow lumen and challenging workspace, and the colon with its tortuous course and folds are more challenging frontiers. The nature of performing a procedure endoscopically means that conventional methods offer no mechanism for providing counter-traction while performing dissection, impeding visibility and increasing the rate of complications. There are a multitude of tools available to those performing ESD for the different stages of the procedure. This article reviews the accessories currently used in regular ESD practice including the knives used to cut and dissect lesions, the cap and hood devices used to improve visibility and safety, injection fluids to lift the submucosal plane, haemostatic devices, generators, and finally, emerging traction apparatus. There is some evidence behind the use of these tools, however, ESD remains the domain of a small number of practitioners and the practice relies heavily on expert experience. Evolution of the ESD toolbox will make the procedure more accessible to more endoscopists, which in turn will drive the development of a more substantial evidence base to evaluate efficacy and safety of the multitude of tools.

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“…Several traction methods for ESD have been investigated to overcome the problem, such as percutaneous traction [ 5 ], clip with line [ 6 – 8 ], clip-and-snare [ 9 ], external grasping forceps [ 10 ], internal traction [ 11 , 12 ], suture-pulley [ 13 ], magnetic anchor [ 14 ], double-channel endoscope [ 15 ], double-endoscope [ 16 ], and robot-assisted method [ 17 ]. However, those traction methods need extra devices or equipment and may be invasive or difficult to control the pulley strength and direction or inconvenient to be operated.…”

Section: Introductionmentioning

confidence: 99%

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

Feng

Linghu

Chai

et al. 2018

Gastroenterology Research and Practice

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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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Effectiveness of clip-and-snare method using pre-looping technique for gastric endoscopic submucosal dissection

Abstract: CSM-PLT was an effective and safe method for gastric ESD.

Cited by 21 publications

References 18 publications

Internal traction method using a spring-and-loop with clip (S–O clip) allows countertraction in gastric endoscopic submucosal dissection

Internal traction method using a spring-and-loop with clip (S–O clip) allows countertraction in gastric endoscopic submucosal dissection

Endoscopic submucosal dissection: an update on tools and accessories

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

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