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

Koichi Hamada
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
2   Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
,
Yoshinori Horikawa
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Yoshiki Shiwa
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Kae Techigawara
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Takayuki Nagahashi
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Daizo Fukushima
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Shinya Nishida
3   Department of Gastroenterology, Shin-yurigaoka General Hospital, Kawasaki, Japan
,
Ryota Koyanagi
2   Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
4   Department of Gastroenterology, Utsunomiya Memorial Hospital, Utsunomiya, Japan
,
Koichiro Kawano
5   Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
,
Noriyuki Nishino
1   Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
,
Michitaka Honda
2   Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
6   Department of Surgery, Southern-Tohoku General Hospital, Koriyama, Japan
› Author Affiliations
Trial Registration: UMIN Japan Registration number (trial ID): UMIN000034048 Type of study: Prospective, randomized, single-center study

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.



Publication History

Received: 10 June 2020

Accepted: 08 September 2020

Article published online:
05 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Japanese GastricCancer Association. Japanese gastric cancer treatment guidelines 2014 (ver4). Gastric Cancer 2017; 20: 1-19
  • 2 Gotoda T, Yanagisawa A, Sasako M. et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
  • 3 Oda I, Saito D, Tada M. et al. A multicenter retrospective study of endoscopic resection for early gastric cancer. Gastric Cancer 2006; 9: 262-270
  • 4 Mannen K, Tsunada S, Hara M. et al. Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions. J Gastroenterol 2010; 45: 30-36
  • 5 Ojima T, Takifuji K, Nakamura M. et al. Complications of endoscopic submucosal dissection for gastric noninvasive neoplasia: an analysis of 647 lesions. Surg Laparosc Endosc Percutan Tech 2014; 24: 370-374
  • 6 Saito I, Tsuji Y, Sakaguchi Y. et al. Complications related to gastric endoscopic submucosal dissection and their managements. Clin Endosc 2014; 47: 398-403
  • 7 Yoo JH, Shin SJ, Lee KM. et al. Risk factors for perforations associated with endoscopic submucosal dissection in gastric lesions: emphasis on perforation type. Surg Endosc 2012; 26: 2456-2464
  • 8 Libanio D, Costa MN, Pimentel-Nunes P. et al. Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis. Gastrointest Endosc 2016; 84: 572-586
  • 9 Kim JW, Jang JY, Park YM. et al. Clinicopathological characteristics of patients with pain after endoscopic submucosal dissection for gastric epithelial neoplasm. Surg Endosc 2019; 33: 794-801
  • 10 Park CH, Kim H, Kang YA. et al. Risk factors and prognosis of pulmonary complications after endoscopic submucosal dissection for gastric neoplasia. Dig Dis Sci 2013; 58: 540-546
  • 11 Imaeda H, Hosoe N, Kashiwagi K. et al. Advanced endoscopic submucosal dissection with traction. World J Gastrointest Endosc 2014; 6: 286-295
  • 12 Miura Y, Hayashi Y, Lefor AK. et al. The pocket-creation method of ESD for gastric neoplasms. Gastrointest Endosc 2016; 83: 457-458
  • 13 Oyama T. Counter traction makes endoscopic submucosal dissection easier. Clin Endosc 2012; 45: 375-378
  • 14 Suzuki S, Gotoda T, Kobayashi Y. et al. Usefulness of a traction method using dental floss and a hemoclip for gastric endoscopic submucosal dissection: a propensity score matching analysis (with videos). Gastrointest Endosc 2016; 83: 337-346
  • 15 Matsumoto K, Konuma H, Ueyama H. et al. Multibending scope use for reduction of perforation risks in endoscopic submucosal dissection. Minim Invasive Ther Allied Technol 2020; 1-9
  • 16 Hamada K, Horikawa Y, Koyanagi R. et al. Usefulness of a multibending endoscope in gastric endoscopic submucosal dissection. VideoGIE 2019; 4: 577-583
  • 17 Tanaka M, Ono H, Hasuike N. et al. Endoscopic submucosal dissection of early gastric cancer. Digestion 2008; 77 (Suppl. 01) 23-28
  • 18 Japanese GastricCancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101-112
  • 19 Chong CC, Chiu PW, Ng EK. Multibend endoscope facilitates endoscopic hemostasis for bleeding gastric ulcer at high lesser curvature. J Laparoendosc Adv Surg Tech A 2008; 18: 837-839
  • 20 Hua XL, Jun LL, Wen ZC. et al. Using a double-channel gastroscope reduces procedural time in performing gastric endoscopic submucosal dissection. Pak J Med Sci 2016; 32: 617-621
  • 21 Imagawa A, Okada H, Kawahara Y. et al. Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy 2006; 38: 987-990
  • 22 Lee SH, Gromski MA, Derevianko A. et al. Efficacy of a prototype endoscope with two deflecting working channels for endoscopic submucosal dissection: a prospective, comparative, ex vivo study. Gastrointest Endosc 2010; 72: 155-160
  • 23 Neuhaus H, Costamagna G, Deviere J. et al. Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy 2006; 38: 1016-1023
  • 24 Yonezawa J, Kaise M, Sumiyama K. et al. A novel double-channel therapeutic endoscope (“R-scope”) facilitates endoscopic submucosal dissection of superficial gastric neoplasms. Endoscopy 2006; 38: 1011-1015
  • 25 Nishizawa T, Uraoka T, Ochiai Y. et al. The “two-sword fencing” technique in endoscopic submucosal dissection. Clin Endosc 2015; 48: 85-86
  • 26 Yamamoto Y, Nishisaki H, Sakai H. et al. Clinical factors of delayed perforation after endoscopic submucosal dissection for gastric neoplasms. Gastroent Res Pract 2017; 2017: 7404613
  • 27 Hirao M, Yamada T, Michida T. et al. Peritoneal seeding after gastric perforation during endoscopic submucosal dissection for gastric cancer. Dig Surg 2018; 35: 457-460
  • 28 Horikawa Y, Mimori N, Mizutamari H. et al. Proper muscle layer damage affects ulcer healing after gastric endoscopic submucosal dissection. Dig Endosc 2015; 27: 747-753
  • 29 Yamamoto Y, Kikuchi D, Nagami Y. et al. Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: review of the literature and recommendations from experts. Dig Endosc 2019; 31: 4-20
  • 30 Yoshida M, Takizawa K, Suzuki S. et al. Conventional versus traction-assisted endoscopic submucosal dissection for gastric neoplasms: a multicenter, randomized controlled trial (with video). Gastrointest Endosc 2018; 87: 1231-1240
  • 31 Yamamoto K, Tanaka K, Hayashi S. et al. A novel handmade “multi-bending endoscope system” for endoscopic submucosal dissection of difficult-to-approach superficial gastric neoplasms. Endoscopy 2019; 51: E83-E84
  • 32 Akasaka T, Nishida T, Tsutsui S. et al. Short-term outcomes of endoscopic submucosal dissection (ESD) for early gastric neoplasm: multicenter survey by Osaka University ESD study group. Dig Endosc 2011; 23: 73-77
  • 33 Ban H, Sugimoto M, Otsuka T. et al. Usefulness of the clip-flap method of endoscopic submucosal dissection: a randomized controlled trial. World J Gastroenterol 2018; 24: 4077-4085
  • 34 Dohi O, Yoshida N, Terasaki K. et al. Efficacy of Clutch Cutter for standardizing endoscopic submucosal dissection for early gastric cancer: a propensity score-matched analysis. Digestion 2019; 100: 201-209
  • 35 Hashimoto R, Hirasawa D, Iwaki T. et al. Usefulness of the S-O clip for gastric endoscopic submucosal dissection (with video). Surg Endosc 2018; 32: 908-914