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

Publication Date:
05 November 2020 (online)

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