Feasibility of electrocautery snaring as the final step of endoscopic submucosal dissection for stomach epithelial neoplasms

O. Goto, M. Fujishiro, S. Kodashima, N. Kakushima, S. Ono, N. Yahagi, M. Omata

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Endoscopic submucosal dissection (ESD) is a novel endoluminal technique that permits the resection of gastric neoplasms. Aim: To analyse the feasibility of snaring as the final step of ESD. Patients and methods: One hundred and ninety-nine consecutive gastric neoplasms resected by four ESD experts from January 2004 to May 2007 were investigated. Forty-five (22.6%) were finally resected finally using a snare. Rates of en bloc resection, complete (R0 plus en bloc) resection, mean operation time, and complications were assessed between the snaring and the non-snaring groups. Results: En bloc resection rate was significantly lower and delayed bleeding rate was significantly higher in the snaring group than in the non-snaring group (91.1% [41/45] vs. 100% [154/154], 11.1% [5/45] vs. 1.9% [3/154], respectively), although complete resection rate (86.7% [39/45] vs. 92.9% [143/154]) and mean operation time (70.2 min vs. 75.8 min) were not significantly different between the two groups. Six perforation cases (3 [6.7%] in the snaring group, 3 [1.9%] in the non-snaring group) were observed, but snaring did not lead to perforation in any case. When the subjects were divided into small (≤2 cm) and large (>2 cm) tumours, en bloc resection rate in large tumours was still significantly different between the groups (76.9% [10/13] vs. 100% [67/67]), whereas in small tumours it was no longer significantly different (96.9% [31/32] vs. 100% [87/87]). Conclusions: Snaring may facilitate successful ESD for smaller tumours, but multiple-piece resection should be taken into account especially for larger tumours.

Original languageEnglish
Pages (from-to)26-30
Number of pages5
JournalDigestive and Liver Disease
Volume41
Issue number1
DOIs
Publication statusPublished - 2009 Jan 1

Keywords

  • Endoscopic submucosal dissection
  • Piecemeal resection
  • Snaring resection
  • Stomach neoplasm

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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