Background and study aim: Endoscopic submucosal dissection (ESD) is a new and radical treatment for superficial gastrointestinal neoplasms that provides high rates of en bloc resection compared with treatment by conventional mucosal resection. However, ESD is a complex procedure that is associated with long operating times and a higher complication rate. This feasibility study assessed the use of a novel double-channel therapeutic endoscope for performing en-bloc ESD in order to assess whether the procedure time could be shortened.
Patients and methods: The therapeutic endoscope we used (the “R-scope”) is equipped with a multibending system and has two movable instrument channels: one moves a grasping forceps vertically for lesion countertraction; the other swings a cutting knife horizontally for dissection. Twenty consecutive patients (18 men, 2 women; mean age 63 years, range 54 - 80 years) with superficial gastric neoplasms in the distal two-thirds of the stomach underwent resection of their tumor by ESD using the R-scope. Forty size- and location-matched gastric neoplasms resected by conventional ESD were reviewed retrospectively for the purposes of comparison.
Results: The rates of curative en-bloc resection, complications, and local recurrence using the two ESD methods were comparable. The mean ± SD operating time was significantly shorter for ESD using the R-scope than for conventional ESD (57.9 ± 29.7 minutes vs. 92.8 ± 58.9 minutes, P = 0.016).
Conclusion: The R-scope appears to shorten the operating time of ESD with comparable efficacy and complication rates.
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M. Kaise, M. D.
Department of Endoscopy
The Jikei University School of Medicine · 3-25-8 Nishi Shinbashi · Minato-ku · Tokyo 103-8461 · Japan
Fax: +81-3-5438-8380
eMail: kaise@jikei.ac.jp
