Reduction in the procedure time of hybrid endoscopic submucosal dissection for early gastric neoplasms: a multi-center retrospective propensity score-matched analysis

Abstract

Background: Endoscopic submucosal dissection (ESD) for early gastric neoplasms is still a technically difficult and time-consuming procedure. Hybrid ESD (H-ESD) involves circumferential incision with partial submucosal dissection combined with subsequent mucosal resection by snaring, wherein the newly developed device allows us to perform H-ESD using a single device. This study aimed to determine the clinical outcomes of H-ESD compared with conventional ESD (C-ESD) for early gastric neoplasms. Methods: In this multi-center, retrospective study, using propensity score-matched analysis, we reviewed the charts of patients with early gastric neoplasms smaller than 20 mm treated with H-ESD or C-ESD at three hospitals between January 2017 and October 2018. The primary outcome was the procedure time, and the secondary outcomes were other factors, including the en bloc resection rate, complete resection rate, curative resection rate, and rate of adverse events. Results: Among 215 patients, 29 underwent H-ESD and 186 underwent C-ESD; 29 pairs were created by propensity score matching. In the H-ESD group, 82.8% of lesions met the absolute indication [mucosal lesions limited to 20-mm diameter, dominated by differentiated adenocarcinoma without ulcer (scar)] for endoscopic resection (ER). As a result, the procedure time of H-ESD was significantly shorter than that of C-ESD [20 (interquartile range, 12–27) min versus 40 (30–50) min; p < 0.001]. There was no significant difference in the secondary outcomes between the two groups. Conclusion: H-ESD contributed to reduced procedure time. Therefore, H-ESD could be an alternative endoscopic treatment for gastric neoplasms when the lesion fulfils the absolute indication for ER.

Efficacy of hybrid endoscopic submucosal dissection with SOUTEN in gastric lesions: An ex vivo porcine model basic study

“…Although there were concerns about the curability of hybrid ESD for lesion that were 10-15 mm in size, hybrid ESD achieved 100% en bloc resection and 93.8% complete resection, which were similar to what was obtainable with conventional ESD. This result was consistent with that of previous clinical studies on hybrid ESD and the treatment of gastric lesions[ 12 , 20 ]. Circumferential mucosal incision, followed by partial mucosal dissection before snaring in a planned manner improves curability using hybrid ESD.…”

“…Furthermore, a recently developed single multifunctional device (SOUTEN; Kaneka Medics, Tokyo, Japan) has enabled us to conduct hybrid ESD at lower cost with a single device than with conventional ESD[ 10 , 11 ]. Recently, we conducted a retrospective study, and showed that hybrid ESD with SOUTEN has shorter total procedure time than conventional ESD in ER for gastric neoplasms, and this finding was consistent with those of other previously reported studies on colonic neoplasms[ 8 , 12 ]. However, the real superiority of hybrid ESD with SOUTEN over conventional ESD remains to be determined since the previously conducted clinical studies had a limitation that SOUTEN was used only in hybrid the ESD group and not in the conventional ESD group where other common endoscopic knives, such as Dual knife, Flush knife and Splash-M knife were used, due to the ethical issues.…”

Comparison of The Procedure Time Differences Between the Hybrid Endoscopic Submucosal Dissection and The Conventional Endoscopic Submucosal Dissection in Patients with Early Gastric neoplasms: A Study Protocol for A Multicenter Randomized Controlled Trial (Hybrid-G Trial)

“…The H-ESD procedure will be performed, as described in detail elsewhere, using a SOUTEN high-frequency surgical knife [12,19]. SOUTEN will be xed with the snare closed, and only the distal tip will be exposed.…”

“…In this study, to test the superiority of H-ESD over C-ESD, the sample size was estimated based on the primary endpoint (the logarithmically converted procedure time for ESD). According to a previous report comparing the treatment outcomes of C-ESD and H-ESD, the logarithmically converted procedure time (minutes, mean ± standard deviation (SD)) for C-ESD and H-ESD was 1.578 ± 0.225 and 1.244 ± 0.228, respectively [12]. Considering these results, we hypothesized that H-ESD would provide a 0.2 (37%) reduction in procedure time and estimated the SD of 0.3 conservatively.…”

“…However, the superiority of H-ESD over C-ESD for EGN is still controversial. One retrospective study has shown a signi cant reduction in procedure time and favorable treatment outcomes with H-ESD, compared with C-ESD [12]. However, another retrospective study failed to show a signi cantly shorter procedure time for H-ESD [13].…”