FEASIBILITY OF CONSCIOUS TRANSNASAL HYBRID ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER IN ELDERLY PATIENTS

Aims:

Endoscopic Submucosal Dissection (ESD) is technically difficult and time-consuming procedure which is performed under sedation. Therefore, ESD has definite risks especially for elderly patients. Transanal hybrid ESD without sedation maybe alternative therapeutic option for achieving, safe, easy and short-time en-bloc resection for superficial gastrointestinal neoplasms.

Methods:

After informed consent was obtained, transnasal Hybrid ESD was performed for elderly patients whose age were over 80 years old and clinical characteristics and outcomes were evaluated retrospectively. 10 gastric lesions were resected by transnasal Hybrid ESD between April 2016 and October 2018. All of the hybrid ESD steps were performed using a newly developed multifunctional snare 'SOUTEN' (Kaneka Medics, Tokyo, Japan) which is design to achieve Hybrid ESD which is available through the transnasal endoscope. The knobshaped tip attached to the loop top helps to stabilize the needle-knife, making it less likely to slip during circumferential incision and enables partial submucosal dissection.

Results:

The mean age was 83.7 ± 6.5 years old, the male to female ration was 7:3. The lesions locations were U/M/L:1/3/6. Mean tumor size and resected specimen size were 9.5 ± 3.2 mm and 19.6 ± 6.0 mm. And mean procedure time was 13.7 ± 3.1 min. En-bloc R0 resection rate were 100% respectively. In all patients, face scale was 1 and oxygen saturation could keep more than 95% during procedure, therefore oxygen administration was not needed.

Conclusions:

We confirmed favorable clinical outcomes of Hybrid ESD without sedation. We believe transansal hybrid ESD without sedation is a useful therapeutic technique for early gastric cancer in elderly patients.