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DOI: 10.1055/s-0034-1377580
Conventional vs. waterjet-assisted endoscopic submucosal dissection in early gastric cancer: a randomized controlled trial
Publikationsverlauf
submitted: 17. August 2013
accepted after revision: 18. Mai 2014
Publikationsdatum:
17. September 2014 (online)
![](https://www.thieme-connect.de/media/endoscopy/201410/lookinside/thumbnails/10.1055-s-0034-1377580-1.jpg)
Background and study aims: A hybrid knife was recently developed to allow waterjet-assisted endoscopic submucosal dissection, which aims to speed up and simplify the procedure. This technique has been shown to be effective and safe for the treatment of early gastric cancer (EGC) but it has not yet been compared with conventional ESD.
Patients and methods: In this two-center study, patients with an endoscopic and histopathological diagnosis of gastric adenoma or early gastric adenocarcinoma (meeting the extended Japanese criteria for local resection) were randomized to either conventional or waterjet-assisted ESD. The choice of knife was left to the endoscopist in the conventional group whereas the hybrid knife was used in the waterjet group. The primary end point was procedure time, and secondary outcomes included rates of en bloc resection, R0 resection, and complications.
Results: A total of 117 patients (mean age 63.0 ± 10.6 years, 76 men) were randomized to either conventional ESD (n = 59; control group) or waterjet-assisted ESD (n = 58). There were no significant differences in patient demographics or lesion features between the groups. The mean procedure time was significantly shorter in the waterjet group compared with the conventional group (27.5 ± 30.6 vs. 35.0 ± 22.5 minutes; P = 0.0008), and a change of accessories was less frequently required (mean number of changes 1.4 ± 2.0 vs. 23.0 ± 15.4; P < 0.0001). There was no significant difference between the groups in the size of resected specimen, R0 resection rates, number of perforations, major delayed bleedings, or rates of complete remission of neoplasia after 3 months.
Conclusions: Waterjet-assisted ESD and conventional ESD are comparably effective and safe techniques for the local treatment of EGC. The waterjet-assisted technique is a faster and simpler procedure and requires fewer accessory changes compared with conventional ESD.
ClinicalTrial.gov registration: NCT01943253
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References
- 1 Gotoda T. A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 2005; 3: 71-73
- 2 Cao Y, Liao C, Tan A et al. Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 2009; 41: 751-757
- 3 Lian J, Chen S, Zhang Y et al. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 2012; 76: 763-770
- 4 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
- 5 Catalano F, Trecca A, Rodella L et al. The modern treatment of early gastric cancer: our experience in an Italian cohort. Surgical endoscopy 2009; 23: 1581-1586
- 6 Dinis-Ribeiro M, Pimentel-Nunes P, Afonso M et al. A European case series of endoscopic submucosal dissection for gastric superficial lesions. Gastrointest Endosc 2009; 69: 350-355
- 7 Probst A, Pommer B, Golger D et al. Endoscopic submucosal dissection in gastric neoplasia – experience from a European center. Endoscopy 2010; 42: 1037-1044
- 8 Schumacher B, Charton JP, Nordmann T et al. Endoscopic submucosal dissection of early gastric neoplasia with a water jet-assisted knife: a Western, single-center experience. Gastrointest Endosc 2012; 75: 1166-1174
- 9 Kaehler GF, Sold MG, Fischer K et al. Selective fluid cushion in the submucosal layer by water jet: advantage for endoscopic mucosal resection. Eur Surg Res 2007; 39: 93-97
- 10 Schumacher B, Neuhaus H, Enderle MD. Experimental use of new device for mucosectomy. Acta Endoscopica 2007; 37: 673-678
- 11 Neuhaus H, Wirths K, Schenk M et al. Randomized controlled study of EMR versus endoscopic submucosal dissection with a waterjet hybrid-knife of esophageal lesions in a porcine model. Gastrointest Endosc 2009; 70: 112-120
- 12 Yahagi N, Neuhaus H, Schumacher B et al. Comparison of standard endoscopic submucosal dissection (ESD) versus an optimized ESD technique for the colon: an animal study. Endoscopy 2009; 41: 340-345
- 13 Neuhaus H, Terheggen G, Rutz EM et al. Endoscopic submucosal dissection plus radiofrequency ablation of neoplastic Barrett’s esophagus. Endoscopy 2012; 44: 1105-1113
- 14 Gotoda T. Endoscopic resection of early gastric cancer: the Japanese perspective. Curr Opin Gastroenterol 2006; 22: 561-569
- 15 Bosman FT, Carneiro F, Hruban RH et al. eds. WHO classification of tumours of the digestive system. 4th edn. Lyon, France: IARC Press; 2010
- 16 Yamaguchi N, Isomoto H, Fukuda E et al. Clinical outcomes of endoscopic submucosal dissection for early gastric cancer by indication criteria. Digestion 2009; 80: 173-181
- 17 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
- 18 Hitomi G, Watanabe H, Tominaga K et al. Endoscopic submucosal dissection in 100 lesions with early gastric carcinoma. Hepatogastroenterology 2009; 56: 254-260
- 19 Gotoda T, Iwasaki M, Kusano C et al. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer Centre criteria. Br J Surg 2010; 97: 868-871
- 20 Ribeiro-Mourao F, Pimentel-Nunes P, Dinis-Ribeiro M. Endoscopic submucosal dissection for gastric lesions: results of an European inquiry. Endoscopy 2010; 42: 814-819
- 21 Deprez PH, Bergman JJ, Meisner S et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy 2010; 42: 853-858
- 22 Neuhaus H. Endoscopic submucosal dissection in the upper gastrointestinal tract: present and future view of Europe. Dig Endosc 2009; 21: 4-S9