Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2021; 13(3): 174-184
Published online Mar 15, 2021. doi: 10.4251/wjgo.v13.i3.174
Efficacy and safety of grasping forceps-assisted endoscopic resection for gastric neoplasms: A multi-centre retrospective study
Ryoji Ichijima, Sho Suzuki, Mitsuru Esaki, Toshiki Horii, Chika Kusano, Hisatomo Ikehara, Takuji Gotoda
Ryoji Ichijima, Sho Suzuki, Mitsuru Esaki, Toshiki Horii, Chika Kusano, Hisatomo Ikehara, Takuji Gotoda, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Chiyoda-ku 101-0062, Tokyo, Japan
Mitsuru Esaki, Department of Medicine and Bioregulatory Sience, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
Toshiki Horii, Department of Gastroenterology, Yuri Kumiai General Hospital, Yurihonjou City 015-8511, Akita, Japan
Author contributions: Ichijima R and Suzuki S drafted and revised the manuscript for important intellectual content; Esaki M and Horii T analysed and interpreted the data; Esaki M, Kusano C, Ikehara H and Gotoda T revised the manuscript for important intellectual content; all authors have read and approved the final version of the manuscript.
Institutional review board statement: The study protocol was approved by the institutional review board of Nihon University Surugadai Hospital.
Informed consent statement: Written informed consent was obtained from the patients before the ESD and GF-ER procedures.
Conflict-of-interest statement: The authors declare that they have no conflict-of-interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Ryoji Ichijima, MD, Doctor, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku 101-0062, Tokyo, Japan. ryoji0331@yahoo.co.jp
Received: December 10, 2020
Peer-review started: December 10, 2020
First decision: December 31, 2020
Revised: January 9, 2021
Accepted: February 1, 2021
Article in press: February 1, 2021
Published online: March 15, 2021
Processing time: 89 Days and 1.1 Hours
Abstract
BACKGROUND

Endoscopic submucosal dissection (ESD) is widely accepted for early gastric cancer (EGC) without lymph node metastasis, although ESD is challenging, even for small lesions, in the greater curvature (GC) of the upper (U) and middle (M) thirds of the stomach. Grasping forceps-assisted endoscopic resection (GF-ER) is a type of endoscopic mucosal resection that is performed via a double-channel endoscope.

AIM

To investigate the safety and efficacy of GF-ER vs ESD in the GC of the stomach’s U and M regions.

METHODS

We retrospectively reviewed the medical records of 506 patients who underwent ER of 522 EGC lesions in the stomach’s U and M regions in three institutions between January 2016 and May 2020. Nine lesions from eight patients who underwent GF-ER for EGC (the GF-ER group) were compared to 63 lesions from 63 patients who underwent ESD (the ESD group). We also performed a subgroup analysis of small lesions (≤ 10 mm) in 6 patients (7 lesions) from the GF-ER group and 20 patients (20 lesions) from the ESD group.

RESULTS

There were no statistically significant differences between the GF-ER and ESD groups in the en bloc resection rates (100% vs 100%) and the R0 resection rates (100% vs 98.4%). The median procedure time in the GF-ER group was shorter than that in the ESD group (4.0 min vs 55.0 min, P < 0.01). There were no adverse events in the GF-ER group, although five perforations (8.0%) and 1 case of postoperative bleeding (1.6%) were observed in the ESD group. When we only considered lesions that were ≤ 10 mm, the median procedure time in the GF-ER group was still shorter than that in the ESD group (4.0 min vs 35.0 min, P < 0.01). There were no adverse events in the GF-ER group, although 1 case of perforation (1.6%) were observed in the ESD group.

CONCLUSION

These findings suggest that GF-ER may be an effective therapeutic option for small lesions in the GC of the stomach’s U and M regions.

Keywords: Gastric cancer; Endoscopic resection; Endoscopic submucosal dissection; Endoscopic mucosal resection; Grasping forceps-assisted endoscopic resection

Core Tip: Endoscopic submucosal dissection (ESD) is widely accepted for early gastric cancer (EGC), although ESD is challenging, even for small lesions, in the greater curvature of the upper and middle thirds of the stomach. The major discoveries and findings in this study are; we found that grasping forceps-assisted endoscopic resection achieved en bloc and R0 resections with significantly shorter procedure times (vs ESD), without any adverse events. Although ESD is considered the first-line treatment for EGC, it is not always necessary to treat lesions in all areas using ESD, and endoscopic mucosal resection is a feasible option if en bloc resection is considered possible, as it can be performed easily and quickly.