Application of single-wide-tunnel endoscopic submucosal dissection with single-clip-line traction for large early esophageal cancer and precancerous lesions
10.3760/cma.j.cn321463-20240217-00233
- VernacularTitle:单个宽隧道结合线夹牵引的内镜黏膜下剥离术在大面积早期食管癌及癌前病变中的应用研究
- Author:
Zhongshang SUN
1
;
Liansong YE
;
Xuelian LI
;
Zhiying GAO
;
Zhenguo PAN
;
Bing HU
;
Feng PAN
Author Information
1. 南京医科大学附属淮安第一医院消化内科，淮安 223300
- Keywords:
Esophageal neoplasms;
Endoscopic submucosal tunnel dissection;
Clip-line traction;
Early esophageal cancer;
Esophageal precancerous lesions
- From:
Chinese Journal of Digestive Endoscopy
2024;41(10):798-804
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinical efficacy of single-wide-tunnel endoscopic submucosal dissection with single-clip-line traction (W-ESTD) for the treatment of early esophageal cancer and precancerous lesions with large area (≥ 3/4 circumference).Methods:A retrospective analysis was performed on patient data of large early esophageal cancer or precancerous lesions treated with digestive endoscopy at the Affiliated Huai'an NO.1 People's Hospital of Nanjing Medical University from January 2018 to January 2023. Patients were divided into W-ESTD group and endoscopic submucosal double-tunnel dissection (D-ESTD) group based on the technique used. Surgical speed, en bloc resection rate, R0 resection rate, curative resection rate, intraoperative and postoperative complications were compared between the two groups.Results:A total of 44 patients with large early esophageal cancer or precancerous lesions were included in this study, including 23 cases in the W-ESTD group and 21 cases in the D-ESTD group. There was no statistically significant difference in baseline data between the two groups ( P>0.05). The operating speeds of W-ESTD and D-ESTD groups were 29.97±11.89 mm2/min and 22.65±6.30 mm2/min, respectively, with significant difference ( t=2.580, P=0.014). There was no statistically significant difference between the two groups in terms of en bloc resection rate [95.7% (22/23) VS 100.0% (21/21), P=1.000], R0 resection rate [87.0% (20/23) VS 90.5% (19/21), P=1.000], or curative resection rate [73.9% (17/23) VS 85.7% (18/21), P=0.462]. No recurrence occurred. Intraoperative muscular injury occurred in 3 cases in the W-ESTD group and 5 cases in the D-ESTD group, and postoperative esophageal stricture occurred in 11 cases and 8 cases respectively, with no significant differences between the two groups ( P>0.05). Conclusion:Compared to D-ESTD, W-ESTD can significantly improve surgical speed and demonstrate itself as a safe and effective approach for treating large early esophageal cancer and precancerous lesions.
