A stag beetle knife can achieve stabler and safer endoscopic submucosal dissection in the esophagus

Kohei Funasaka; Noriyuki Horiguchi; Hyuga Yamada; Keishi Koyama; Tomomitsu Tahara; Mitsuo Nagasaka; Yoshihito Nakagawa; Eizaburo Ohno; Teiiji Kuzuya; Ryoji Miyahara; Tomoyuki Shibata; Yoshiki Hirooka

doi:10.1055/a-2198-1013

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(12): E1130-E1137
DOI: 10.1055/a-2198-1013

Original article

A stag beetle knife can achieve stabler and safer endoscopic submucosal dissection in the esophagus

Kohei Funasaka

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Noriyuki Horiguchi

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Hyuga Yamada

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Keishi Koyama

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Tomomitsu Tahara

²Internal Medicine 3, Kansai Medical University, Hirakata, Japan (Ringgold ID: RIN12880)

,

Mitsuo Nagasaka

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Yoshihito Nakagawa

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Eizaburo Ohno

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Teiiji Kuzuya

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Ryoji Miyahara

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Tomoyuki Shibata

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

,

Yoshiki Hirooka

¹Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan (Ringgold ID: RIN12695)

› Institutsangaben

Abstract

Background and study aims Esophageal endoscopic submucosal dissection (ESD) has a higher complication rate than gastric ESD. Scissor-type devices, including the stag beetle (SB) knife, are reportedly safer and have shorter procedure times than tip devices. To clarify the characteristics of the SB knife, we compared the treatment outcomes of esophageal ESD with a tip-type knife to those with an SB knife combination.

Patients and methods Between January 2016 and March 2023, clinical data from 197 lesions in 178 patients who underwent esophageal ESD were analyzed retrospectively. Every lesion was assigned to either the tip-type group or the SB group based on the devices with which the submucosa was initially dissected. We compared procedure time and complications and analyzed the risk of muscular exposure using multivariate analysis.

Results Procedure time was not significantly different between the tip-type and SB groups (60.3±42.2 min vs. 58.8±29.1 min). The variation in procedure time was significant according to F test P=0.002). Incidence of muscular exposure was significantly lower in the SB group than in the tip-type group (24.5% vs. 11.1%, P=0.016). These differences were significant in resected specimens larger than 21 mm. Procedure time over 60 minutes (odds ratio [OR] 2.5, 95% confidence interval [CI]: 1.15–5.42, P=0.02) was a risk factor for muscular exposure, and submucosal dissection with an SB knife was a safety factor (OR 0.4, 95% CI: 0.18–0.89, P=0.02).

Conclusions Performing esophageal ESD with an SB knife is a safe procedure with less variation in procedure time and less muscule exposure.

Keywords

Quality and logistical aspects - Performance and complications

Volltext

Referenzen

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