Clinical benefit of the multibending endoscope for gastric endoscopic submucosal dissection: a randomized controlled trial

Koichi Hamada; Yoshinori Horikawa; Yoshiki Shiwa; Kae Techigawara; Takayuki Nagahashi; Daizo Fukushima; Shinya Nishida; Ryota Koyanagi; Koichiro Kawano; Noriyuki Nishino; Michitaka Honda

doi:10.1055/a-1288-0570

Endoscopy, Inhaltsverzeichnis

Endoscopy 2021; 53(07): 683-690
DOI: 10.1055/a-1288-0570

Original article

Clinical benefit of the multibending endoscope for gastric endoscopic submucosal dissection: a randomized controlled trial

Autor*innen

Koichi Hamada

¹Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan

²Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
Yoshinori Horikawa

¹Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
Yoshiki Shiwa

¹Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
Kae Techigawara

¹Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
Takayuki Nagahashi

¹Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
Daizo Fukushima

¹Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
Shinya Nishida

³Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
Ryota Koyanagi

²Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan

⁴Department of Gastroenterology, Utsunomiya Memorial Hospital, Utsunomiya, Japan
Koichiro Kawano

⁵Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
Noriyuki Nishino

¹Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
Michitaka Honda

²Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan

⁶Department of Surgery, Southern-Tohoku General Hospital, Koriyama, Japan

Abstract

Background Endoscopic submucosal dissection (ESD) is a technically difficult and time-consuming procedure. We aimed to investigate the efficacy and safety of ESD using a multibending endoscope to treat superficial gastrointestinal neoplasms.

Methods Patients with a single early gastric cancer who met the absolute or expanded indications for ESD according to the Japanese gastric cancer treatment guidelines were enrolled and randomly assigned to undergo ESD using a conventional endoscope (C-ESD) or a multibending endoscope (M-ESD). Randomization was stratified by ESD operator experience and tumor location. The primary outcome was ESD procedure time, calculated as the time from the start of submucosal injection to complete removal of the tumor.

Results 60 patients were analyzed (30 C-ESD, 30 M-ESD). The mean (standard deviation [SD]) ESD procedure times for M-ESD and C-ESD were 34.6 (SD 17.2) and 47.2 (SD 26.7) minutes, respectively (P = 0.03). Muscle layer damage occurred significantly less frequently with M-ESD (0.2 [SD 0.7] vs. 0.7 [SD 1.0]; P = 0.04). There were no significant differences between the two techniques in procedure time or damage to muscle layers for tumors located in the lower third of the stomach.

Conclusions ESD procedure time was significantly shorter with the multibending endoscope and fewer muscles were damaged. We recommend multibending endoscopy for ESD in the upper and middle thirds of the stomach to reduce procedure time and incidence of complications.

Volltext

Referenzen

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