Background and Aims

During endoscopic submucosal dissection (ESD), a clear view is essential for precise dissection of the appropriate submucosal layer. Some advantages have been reported for underwater techniques of endoscopic resection in comparison with the gas insufflation method. We have developed a new ESD method with the creation of a local water-pocket that provides a clear view in the dissection field. Therefore, we aimed to investigate the feasibility and safety of water-pocket ESD (WP-ESD) for superficial gastric neoplasms.

Methods

We prospectively recruited 50 patients with gastric neoplasms (early gastric cancer or gastric adenomas) between April 2017 and December 2017. Among them, 48 patients were treated with the WP-ESD technique. The patients undergoing WP-ESD were compared with 48 patients treated with standard ESD (S-ESD) who were selected by propensity score matching. The primary outcome was the ESD procedure time.

Results

Total procedure time was significantly shorter in the WP-ESD group than in the S-ESD group (median [IQR], 27.5 [19-45] min vs 41 [29.8-69] min; P < 0.001). Similarly, the dissection speed was significantly greater in the WP-ESD group than in the S-ESD group (median [IQR], 22.5 [16.8-35.3] mm²/min vs. 17.3 [12.7-22.1] mm²/min; P < 0.001). The rates of complete en bloc resection in the WP-ESD group and the S-ESD group were 97.9% and 95.8%, respectively (P > 0.99). There were no perforations in either group.

Conclusions

WP-ESD was associated with a shorter procedure time than S-ESD. WP-ESD may provide an alternative method for resection of superficial gastric neoplasms.

中文翻译：

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水袋内镜黏膜下剥离术治疗浅表胃肿瘤（附视频）

背景和目标

在内窥镜下黏膜下剥离术（ESD）期间，清晰观察对于正确剥离适当的黏膜下层至关重要。与气体吹入法相比，已经报道了水下内窥镜切除术的一些优点。我们开发了一种新的ESD方法，其中创建了一个局部水袋，该水袋可在解剖区域内提供清晰的视野。因此，我们旨在研究水袋静电防护（WP-ESD）治疗浅表性胃肿瘤的可行性和安全性。

方法

我们在2017年4月至2017年12月期间招募了50例胃肿瘤（早期胃癌或胃腺瘤）患者。其中48例接受了WP-ESD技术治疗。将接受WP-ESD的患者与通过倾向评分匹配选择的48例接受标准ESD（S-ESD）治疗的患者进行了比较。主要结果是ESD手术时间。

结果

WP-ESD组的总手术时间明显少于S-ESD组（中位[IQR]，27.5 [19-45] min vs 41 [29.8-69] min；P <0.001）。同样，WP-ESD组的解剖速度明显高于S-ESD组（中位数[IQR]，22.5 [16.8-35.3] mm ² / min对17.3 [12.7-22.1] mm ² / min；P <0.001）。WP-ESD组和S-ESD组的整体切除率分别为97.9％和95.8％（P > 0.99）。两组均无穿孔。

结论

与S-ESD相比，WP-ESD的手术时间更短。WP-ESD可能提供一种切除浅表胃肿瘤的替代方法。