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.
