Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 25, 2016; 8(12): 451-457
Published online Jun 25, 2016. doi: 10.4253/wjge.v8.i12.451
Effectiveness of clip-and-snare method using pre-looping technique for gastric endoscopic submucosal dissection
Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura
Naohiro Yoshida, Hisashi Doyama, Ryosuke Ota, Yasuhito Takeda, Hiroyoshi Nakanishi, Kei Tominaga, Shigetsugu Tsuji, Kenichi Takemura, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 920-8530, Japan
Author contributions: Yoshida N designed and performed the research and wrote the paper; Doyama H designed the research and supervised the report; Ota R, Takeda Y, Nakanishi H, Tominaga K, Tsuji S and Takemura K supervised the report.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Ishikawa Prefectural Central Hospital No. 544.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. For full disclosure, the details of the study were published on the home page of Ishikawa Prefectural Central Hospital.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naohiro Yoshida, MD, Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-Higashi, Kanazawa city, Ishikawa 920-8530, Japan. ynaohiro@ipch.jp
Telephone: +81-76-2378211 Fax: +81-76-2382377
Received: February 9, 2016
Peer-review started: February 9, 2016
First decision: March 14, 2016
Revised: April 6, 2016
Accepted: May 7, 2016
Article in press: May 9, 2016
Published online: June 25, 2016
Processing time: 132 Days and 22.1 Hours
Abstract

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-PLT group) 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.

Keywords: Endoscopic submucosal dissection; Clip-and-snare method; Pre-looping technique; Endoscope; Dissection

Core tip: This was a retrospective matched-pair analysis to evaluate the efficacy and safety of clip-and-snare method using pre-looping technique (CSM-PLT) for gastric endoscopic submucosal dissection (ESD). CSM-PLT is one of the traction methods that was developed to perform gastric ESD more effectively. Compared with conventional ESD, ESD using CSM-PLT had significantly shorter total procedure time (38.5 min vs 59.5 min, P = 0.023). With regard to proportion of en bloc resection and complications, there was no significant difference between the groups. Hence, CSM-PLT is a promising method for gastric ESD.