Effectiveness of clip-and-snare method using pre-looping technique for gastric endoscopic submucosal dissection

• 作者: Hiroyoshi Nakanishi Hisashi Doyama Kei Tominaga Kenichi Takemura Naohiro Yoshida Ryosuke Ota Shigetsugu Tsuji Yasuhito Takeda
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 关键词: Endoscopic submucosal DISSECTION Clipand-snare METHOD Pre-looping TECHNIQUE Endoscope DISSECTION
• 年，卷（期）: 2016,（12）
• 页码范围: 451-457
• 页数: 7页
• 分类号: R

摘要

AIM: To evaluate efficacy and safety of clip-and-snare method using pre-looping technique (CSM-PLT) for gastric endoscopic submucosal dissection (ESD). METHODS: In the CSM-PLT method, a clip attached to the lesion side was strangulated with a snare, followed by application of an appropriate tension to the lesion independent of an endoscope. Twenty consecutive lesions were resected by ESD using CSM-PLT (CSM-PLTgroup) and compared with a control group, including 20 lesions that were resected by conventional ESD.The control group was matched based on the size and location of the lesion, presence of pathologic fibrosis,and experience of endoscopists. Total procedure time of ESD, proportion of en bloc resection, and complications were analyzed. RESULTS: The total procedure time for the CSM-PLT group was significantly shorter than that for the control group (38.5 min vs 59.5 min, P = 0.023); all lesions were resected en bloc by ESD. There was no significant difference in complications between the two groups. Moreover, there was no complication in the CSM-PLT group. In one large lesion (size: 74 mm) that underwent extensive CSM-PLT during ESD, we used an additional CSM-PLT on another edge of the lesion after achieving submucosal resection to the maximum extent possible during initial CSM-PLT. In two lesions, the snare came off the lesion together with the clip after a sudden pull; nevertheless, ESD was successful in all lesions.CONCLUSION: CSM-PLT was an effective and safe method for gastric ESD.