A Multicenter Study Of Endoscopic Submucosal Tunnel Dissection For Early Digestive Cancer And Precancerous Lesions

PartⅠA multicenter retrospective study of endoscopic submucosal tunnel dissection for large lesser gastric curvature superficial neoplasmsAim: ESTD(endoscopic submucosal tunnel dissection)has been used for dissection of esophageal.However,outcomes of ESTD for large lesions in the lesser gastric curvature had not been acknowledged because previous reports had the limitations of being single center studies.We aimed to clarify the outcomes of ESTD for large lesser gastric curvature superficial neoplasms and provide our experience to accelerate its application.Methods: Between July 2014 and July 2017,87 patients with early cancer in the lesser gastric curvature treated at six Chinese institutions were enrolled.O f these,32 underwent ESTD and 55 underwent endoscopic submucosal dissection.Results: Of the 87 patients,macroscopic types were classified as 0-Ⅱa+Ⅱc in 18 cases,0-Ⅱb in 47 cases,0-Ⅱc in 4 cases,and 0-Ⅱa in 18 cases.According to the Vienna classification,24 showed mucosal carcinoma,42 showed high-grade intraepithelial neoplasia,and 21 showed low-grade intraepithelial neoplasia.The ESTD group had a higher dissection speed(18.0±7.1 mm2/min vs.7.8±4.8 mm2/min,p<0.01)and was associated with higher en bloc resection rate(100% vs.87.3%,p=0.035)and curative resection rate(100% vs.85.5%,p=0.024)compared with the ESD gro up.No perforation or muscular injury occurred in the ESTD group and its intraprocedural bleeding rate was lower(59.4% vs.100%,p<0.01)than that of the ESD group.In this study,83 patients were included in the follow-up(3 were lost to follow-up,1 underwent additional surgery).The mean follow-up period was 12.4±6.8 months.Recurrence was found in 1 patient in the ESD group and no recurrence occurred in the ESTD group.Conclusions: 1.In this multicenter retrospective study,outcomes of ESTD were excellent with a higher dissection speed and radical curative rate compared with ESD.2.Standardization of the operation is crucial to avoid adverse events.Part ⅡA multicenter retrospective study of endoscopic submucosal tunnel dissection for laterally spreading tumorsAim: To evaluate the efficacy,safety and long-term prognosis of endoscopic submucosal tunnel dissection for the treatment of laterally spreading tumors(LSTs).Materials and Methods: Between June,2013 and June 2017,108 patients with huge laterally spreading tumors(≥3 cm)at five Chinese institutions were enrolled.Of these,42 underwent ESTD and 66 underwent endoscopic submucosal dissection(ESD).Results: ESTD group was associated with a higher dissection speed(15.1±5.1 mm2/min vs 7.0±6.8 mm2/min,P<0.01)and had a higher curative resection rate and en bloc resection rate compared with the ESD group(100% vs 68.2%,p<0.01,100% vs.80.3%,p<0.01).No perforation occurred in the patients,and the intraprocedural bleeding rate and muscular injury rate in ESTD group were lower(47.6% vs.97.0%,P<0.01;4.8% vs.45.5%,P<0.01).In this study,100 patients were included in the follow-up(3 were lost to follow-up,5 underwent additional surgery).The mean follow-up period was 13.7±9.1months.Recurrence were found in 3 patient in the ESD group and no recurrence occurred in the ESTD group.Conclusions: 1.Outcomes of ESTD were excellent with a higher dissection speed and radical curative rate compared with ESD.2.Standardization of the operation is crucial to avoid adverse events.