Traction-assisted ESD of gastric neoplasms cuts procedure time in some patients

Last Updated: 2018-01-17

By Reuters Staff

NEW YORK (Reuters Health) - Traction-assisted endoscopic submucosal dissection (ESD) of gastric neoplasms reduces procedure time for high-risk lesions, compared with conventional ESD, researchers from Japan report.

ESD allows minimally invasive removal of superficial gastrointestinal neoplasms with favorable outcomes. But lesions in the greater curvature of the upper or middle stomach are difficult to manage because they sink under the weight of liquid and collapse under the weight of the lesion itself.

The traction-assisted approach enables the operator to suspend lesions and obtain sufficient visualization of the dissection line for more problematic lesions.

Dr. Kohei Takizawa from Shizuoka Cancer Center, in Shizuoka, Japan, and colleagues from 14 cancer centers and hospitals in Japan investigated whether dental floss clip traction-assisted ESD (DFC-ESD) reduces procedure time or affects technical outcomes, compared with conventional ESD, in their randomized study of 640 patients with gastric neoplasms.

The mean ESD procedure time (the principal endpoint) did not differ significantly between conventional ESD (60.7 minutes) and DFC-ESD (58.1 minutes), the team reports in Gastrointestinal Endoscopy, online December 9.

In the subgroup of patients with lesions located in the greater curvature of the upper or middle stomach, however, the mean procedure time was 45.1% shorter in the DFC-ESD group than in the conventional ESD group (57.2 vs. 104.1 minutes; P=0.01).

The mean ESD procedure time was 17.6% shorter for DFC-ESD than for conventional ESD in high-volume centers for all tumor locations combined.

There were significantly fewer perforations with DFC-ESD than with conventional ESD (0.3% vs. 2.2%; P=0.04).

"The hypothesis that DFC traction enables more expeditious ESD could not be demonstrated in the overall study population," the researchers conclude. "However, DFC reduced the risk of intra-procedural perforation. Considering the substantial reduction in ESD procedure time for high-risk lesions, our results suggest that DFC-ESD should be selectively applied according to tumor location."

Dr. Takizawa did not respond to a request for comment.

SOURCE: http://bit.ly/2DHVgsp

Gastrointest Endosc 2017.