Usefulness of the thread-traction method in esophageal endoscopic submucosal dissection: Randomized controlled trial

• Published in: Digestive endoscopy Vol. 27; no. 3; pp. 303 - 309
• Main Authors: Koike, Yoshiki, Hirasawa, Dai, Fujita, Naotaka, Maeda, Yuki, Ohira, Tetsuya, Harada, Yoshihiro, Suzuki, Kenjiro, Yamagata, Taku, Tanaka, Megumi
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.03.2015
• Subjects: Aged; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; clip with thread; countertraction; Dissection - instrumentation; Dissection - methods; endoscopic submucosal dissection (ESD); Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagoscopy - methods; Female; Follow-Up Studies; hook knife; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Mucous Membrane - pathology; Mucous Membrane - surgery; Operative Time; Pain, Postoperative - physiopathology; Pain, Postoperative - therapy; Patient Safety; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - physiopathology; Postoperative Hemorrhage - therapy; Risk Assessment; squamous cell carcinoma; Surgical Instruments; Survival Rate; Treatment Outcome; clip with thread; hook knife; countertraction; endoscopic submucosal dissection (ESD); squamous cell carcinoma
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/den.12396

Background and Aim To assess the usefulness of the thread‐traction method (TT method) in esophageal endoscopic submucosal dissection (ESD). Methods A total of 40 lesions that were scheduled to be treated by esophageal ESD were included in the study. The TT method was used for 20 lesions (group TT) and conventional ESD was used for 20 lesions (group C) after randomization. The hook‐knife method was used in all cases. In group TT, after circumferential mucosal incision, a clip with thread was attached to the oral edge of the lesion. Results ESD was carried out in all cases. Effective countertraction was created by the TT method, and it was possible to carry out an efficient dissection operation. Significant shortening of dissection time was achieved in group TT compared with group C (19.8 min vs 31.8 min, P = 0.044). Mean number of local injections during dissection was significantly less in group TT compared with that in group C (0.6 times vs 2.2 times, P < 0.001). As for the amount of local injection, group TT required significantly less compared with group C (2.6 mL vs 7.5 mL, P < 0.01). No complications were encountered. Conclusion The TT method in esophageal ESD was safe and contributed to shortening of dissection time. The TT method is expected to become widespread as a safe and useful procedure.