Reduction in the procedure time of hybrid endoscopic submucosal dissection for early gastric neoplasms: a multi-center retrospective propensity score-matched analysis

被引:7
作者
Esaki, Mitsuru [2 ,3 ]
Suzuki, Sho [2 ,4 ]
Horii, Toshiki [2 ,4 ]
Ichijima, Ryoji [2 ]
Yamakawa, Shun [2 ]
Shibuya, Hitoshi [2 ,4 ]
Kusano, Chika [2 ,4 ]
Ikehara, Hisatomo [2 ]
Gotoda, Takuji [1 ]
机构
[1] Nihon Univ, Dept Med, Div Gastroenterol & Hepatol, Sch Med,Chiyoda Ku, 1-6 Kanda Surugadai, Tokyo 1018309, Japan
[2] Nihon Univ, Dept Med, Div Gastroenterol & Hepatol, Sch Med, Tokyo, Japan
[3] Kyushu Univ, Grad Sch Med Sci, Dept Med & Bioregulatory Sci, Fukuoka, Japan
[4] Yuri Kumiai Gen Hosp, Dept Gastroenterol, Akita, Japan
关键词
endoscopic submucosal dissection; gastric neoplasm; propensity score matching; CLINICAL-OUTCOMES; MUCOSAL RESECTION; EFFICACY; CANCER; TUMORS; EMR; INCISION; ESD;
D O I
10.1177/1756284820939420
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: Endoscopic submucosal dissection (ESD) for early gastric neoplasms is still a technically difficult and time-consuming procedure. Hybrid ESD (H-ESD) involves circumferential incision with partial submucosal dissection combined with subsequent mucosal resection by snaring, wherein the newly developed device allows us to perform H-ESD using a single device. This study aimed to determine the clinical outcomes of H-ESD compared with conventional ESD (C-ESD) for early gastric neoplasms. Methods: In this multi-center, retrospective study, using propensity score-matched analysis, we reviewed the charts of patients with early gastric neoplasms smaller than 20 mm treated with H-ESD or C-ESD at three hospitals between January 2017 and October 2018. The primary outcome was the procedure time, and the secondary outcomes were other factors, including the en bloc resection rate, complete resection rate, curative resection rate, and rate of adverse events. Results: Among 215 patients, 29 underwent H-ESD and 186 underwent C-ESD; 29 pairs were created by propensity score matching. In the H-ESD group, 82.8% of lesions met the absolute indication [mucosal lesions limited to 20-mm diameter, dominated by differentiated adenocarcinoma without ulcer (scar)] for endoscopic resection (ER). As a result, the procedure time of H-ESD was significantly shorter than that of C-ESD [20 (interquartile range, 12-27) minversus40 (30-50) min;p < 0.001]. There was no significant difference in the secondary outcomes between the two groups. Conclusion: H-ESD contributed to reduced procedure time. Therefore, H-ESD could be an alternative endoscopic treatment for gastric neoplasms when the lesion fulfils the absolute indication for ER.
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页数:10
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