Modified technique of tumor traction in endoscopic submucosal dissections in the stomach (ex vivo study)

Abstract

Background: the method of endoscopic submucosal dissection (ESD) allows to remove large neoplasms of the GI tract enblock, which significantly reduces the risk of local tumor recurrence. However, ESD method is technically complicated with high risk of surgical complications.
Aim: to modify ESD traction technique and evaluate its efficiency.
Materials and methods: experimental comparative study on biological preparations (pig stomachs). 144 ESD with three different methods were performed: the 1^st group—standard ESD method (n-48); the 2^nd—ESD with the method of traction with the clip and thread (n-48); the 3^rd—ESD with a modified method of tumor traction (n-48).
Results: the shortest time to submucosal dissection was 4.89 min [2–12] in the 3^rd group, and 13,27 [4–31] min and 9,37 [4–26] min in the 1^st and 2^nd, respectively (p = 0,05). Total operative time in the 3^rd was 21,10 [12–31] min, in the 1^st 23.85 [12–48] min, and in the 2^nd—25.56 [13–49] min, p = 0.002. The max dissection speed was 0.48 [0.20–1.27] (min/cm²) in the 3^rd group, 0.94 [0.47–2.06] (min/cm²) and 1.48 [0.56–4.10] (min/cm²) in the 2^nd and 3^rd, respectively, p=0.003. HM0 was 89.6% [43/48] in group 1, 93.7% [45/48] in the 2^nd, and 100% [48/48] in the 3^rd, p>0.05. Muscle layer damage during submucosal dissection was 25% [12/48] in the 1^st, 6.25% [3/48] in the 2^nd and 12.5% [6/48] in 3^rd, p=0.389.
Conclusion: the modified traction method during endoscopic submucosal dissection allows to visualize submucosa layer better, to increase dissection speed thus reducing total time of the operation and time of submucosal dissection.