PTH-031 Application of the clip-band traction method for gastric endoscopic submucosal dissection

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Abstract

Introduction

Endoscopic Submucosal Dissection (ESD) is still limited in Western countries. The phase of submucosal dissection is the most challenging one due to the reduced visibility of the dissection plane. The Clip-Band traction method has shown to be useful and safe in animal models. This study aimed to evaluate the results of gastric ESD in humans with this method.

Method

Patients with epithelial gastric neoplasias as indicated for endoscopic resection according to the expanded Japanese criteria, underwent ESD with different knives plus the Clip-Band method. Performance of ESD, en bloc/curative resection, histological diagnosis and complications were evaluated.

Results

21 lesions (19 patients; age 68 years±10 years) by four endoscopists (16,2,2,1 cases). According to Paris Classification there were 8(IIa), 2(IIa+IIb), 3(IIa+IIc), 1(Ib), 1(Ib+Ic), 1(IIc+III),1(l+lla) and 4 subepithelial lesions. Location was in the upper body (1), mid body (4), lower body (10), antrum (6). The time (median, range) for the circumferential cutting was 22 min (2-100), for the dissection after having applied the traction method 18 min (5-126), and the total dissection time 55 min (6-171). The maximum diameter(median, range) of the specimen was 3.0 cm (1.1–4.7), and the dissection speed (median, range) was 0.085cm2/min(0.03–0.35). There were neuroendocrine tumours(3), inflammatory fibroid polyp (1), neoplasia (17) (Low grade intraepithelial neoplasia 3, high grade intraepitheial neoplasia 7, Intramucosal carcinoma 7). En bloc resection was achieved in all cases; in 2 neuroendocrine lesions the vertical margin was positive (one of them requiring additional surgery). There was one case of delayed bleeding.

Conclusion

The Clip-Band method for gastric ESD provides good results, and can be applied in different gastric locations. The dissection phase is simplified, as the time for the dissection phase (the most challenging part of gastric ESD) is similar to the time for circumferential cutting. However randomised studies will be required to prove this.

Disclosure of Interest

None Declared

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