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Efficacy and safety of esophageal submucosal tumors treated with internal traction method-assisted submucosal tunneling endoscopic resection: a single-center, single-blind, randomized controlled study

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Abstract

Background and objectives

Submucosal tunnel endoscopic resection (STER) is an effective technique for treating esophageal submucosal tumors, but the efficacy and safety of treating esophageal submucosal tumors with internal traction method-assisted STER have not been determined. The objectives of this study were to assess the feasibility, safety, and efficacy of internal traction method-assisted STER for the removal of esophageal submucosal tumors.

Patients and methods

Eighty patients who underwent STER for esophageal submucosal tumors were included in the study. They were randomized and assigned to the two groups. The dual-knife method was used for STER. Forty patients underwent conventional STER (control group) and 40 underwent internal traction method-assisted STER in which self-made rubber band traction with clips was used (study group). In the study group, one end of the self-made rubber band was fixed on the surface of esophageal submucosal tumors with a clip, and the other end of the self-made rubber band was set on the anal side of the contralateral esophageal wall with a clip.

Results

STER was successful in all cases. Lesion features and demographics were similar between the two groups. In addition, broad exposure of the submucosal tissue was obtained by applying tension to the self-made rubber band traction with clips. The en bloc resection rate and complete resection rate were both 100% in the study group. However, the en bloc resection rate and complete resection rate were 85.0% and 100%, respectively, in the control group. Complications, such as perforation and pneumomediastinum, were significantly reduced in the study group, and there was a significant difference in the number of occurrences of bleeding, operation duration, fasting time, and patient length of stay between the study group and control group (P < 0.05). During the mean 13.7 month follow-up, there were no patients with esophageal fistula, recurrence, or distant metastasis in either group.

Conclusions

This original study showed that esophageal submucosal tumors could be effectively and safely treated with internal traction method-assisted STER, and this technique might be superior to conventional STER due to its fewer complications, shorter operation duration, and shorter inpatient length of stay.

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Data availability

The data used to support the findings of this study are available from the corresponding author upon request (Guizhou Wang and Qiao Mei).

References

  1. Yang B, Han H, Shen J et al (2022) Endoscopic resection of large subepithelial esophageal lesions via submucosal tunneling endoscopic resection and endoscopic submucosal dissection: a single-center, retrospective cohort study. Scand J Gastroenterol 57(5):633–641

    Article  CAS  PubMed  Google Scholar 

  2. Shin S, Choi YS, Shim YM et al (2014) Enucleation of esophageal submucosal tumors: a single institution’s experience. Ann Thorac Surg 97(2):454–459

    Article  PubMed  Google Scholar 

  3. Liu BR, Liu BL, Wang XH et al (2017) Esophageal insufflation computed tomography for the diagnosis and management of esophageal submucosal tumors. Surg Endosc 31(5):2350–2355

    Article  PubMed  Google Scholar 

  4. Ponte Neto FL, de Moura DTH, Sagae VMT et al (2021) Endoscopic resection of esophageal and gastric submucosal tumors from the muscularis propria layer: submucosal tunneling endoscopic resection versus endoscopic submucosal excavation: a systematic review and meta-analysis. Surg Endosc 35(12):6413–6426

    Article  PubMed  Google Scholar 

  5. Liu J, Wang Y, Liu Z et al (2021) Submucosal tunneling endoscopic resection treatment of multiple gastrointestinal submucosal tumors. J Gastroenterol Hepatol 36(9):2575–2580

    Article  PubMed  Google Scholar 

  6. Wehrmann T, Martchenko K, Nakamura M et al (2004) Endoscopic resection of submucosal esophageal tumors: a prospective case series. Endoscopy 36(9):802–807

    Article  CAS  PubMed  Google Scholar 

  7. Chen Y, Wang M, Zhao L et al (2020) The retrospective comparison between submucosal tunneling endoscopic resection and endoscopic submucosal excavation for managing esophageal submucosal tumors originating from the muscularis propria layer. Surg Endosc 34(1):417–428

    Article  PubMed  Google Scholar 

  8. von Rahden BH, Stein HJ, Feussner H et al (2004) Enucleation of submucosal tumors of the esophagus: minimally invasive versus open approach. Surg Endosc 18(6):924–930

    Article  Google Scholar 

  9. Shi Q, Zhong YS, Yao LQ et al (2011) Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer. Gastrointest Endosc 74(6):1194–1200

    Article  PubMed  Google Scholar 

  10. Koike Y, Hirasawa D, Fujita N et al (2015) Usefulness of the thread-traction method in esophageal endoscopic submucosal dissection: randomized controlled trial. Dig Endosc 27(3):303–309

    Article  PubMed  Google Scholar 

  11. Xu MD, Cai MY, Zhou PH et al (2012) Submucosal tunneling endoscopic resection: a new technique for treating upper GI submucosal tumors originating from the muscularis propria layer (with videos). Gastrointest Endosc 75(1):195–199

    Article  PubMed  Google Scholar 

  12. Chai N, Du C, Gao Y et al (2018) Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic enucleation for esophageal submucosal tumors originating from the muscularis propria layer: a randomized controlled trial. Surg Endosc 32(7):3364–3372

    Article  PubMed  Google Scholar 

  13. Du C, Ma L, Chai N et al (2018) Factors affecting the effectiveness and safety of submucosal tunneling endoscopic resection for esophageal submucosal tumors originating from the muscularis propria layer. Surg Endosc 32(3):1255–1264

    Article  PubMed  Google Scholar 

  14. Kitagawa Y, Suzuki T, Hara T et al (2018) Safety and efficacy of endoscopic submucosal dissection using IT knife nano with clip traction method for early esophageal squamous cell carcinoma. Surg Endosc 32(1):450–455

    Article  PubMed  Google Scholar 

  15. Kinoshita J, Iguchi M, Maekita T et al (2022) Traction method versus conventional endoscopic submucosal dissection for gastric epithelial neoplasms: a randomized controlled trial. Medicine 101(13):e29172

    Article  PubMed  PubMed Central  Google Scholar 

  16. Jin P, Fu KI, Yu Y et al (2017) Traction using a clip-with-line is a preferred method for trainees in performing esophageal endoscopic submucosal dissection: an animal model study. Therap Adv Gastroenterol 10(4):343–351

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mitsui T, Kadota T, Wakabayashi M et al (2022) Factors of technical difficulty in conventional and traction-assisted esophageal endoscopic submucosal dissection. Esophagus 19(3):452–459

    Article  PubMed  Google Scholar 

  18. Suzuki Y, Tanuma T, Nojima M et al (2020) Multiloop as a novel traction method in accelerating colorectal endoscopic submucosal dissection. Gastrointest Endosc 91(1):185–190

    Article  PubMed  Google Scholar 

  19. Nagata M (2020) Internal traction method using a spring-and-loop with clip (S-O clip) allows countertraction in gastric endoscopic submucosal dissection. Surg Endosc 34(8):3722–3733

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zhang Q, Yao X, Cai JQ et al (2019) Snare combined with endoclips in endoscopic submucosal dissection with mucosal traction for gastroesophageal neoplasia. J Gastroenterol Hepatol 34(6):1049–1057

    Article  PubMed  Google Scholar 

  21. Chen T, Zhou PH, Chu Y et al (2017) Long-term Outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg 265(2):363–369

    Article  PubMed  Google Scholar 

  22. Chen H, Xu Z, Huo J et al (2015) Submucosal tunneling endoscopic resection for simultaneous esophageal and cardia submucosal tumors originating from the muscularis propria layer (with video). Dig Endosc 27(1):155–158

    Article  PubMed  Google Scholar 

  23. Di S, Qiang S, ZhiPeng Q et al (2022) Correction to: Improved submucosal tunneling endoscopic resection with slant tunnel for submucosal tumors in proximal esophagus. Surg Endosc 36(3):2217

    Article  PubMed  Google Scholar 

  24. Xu JQ, Xu JX, Xu XY et al (2022) Landscape of esophageal submucosal tunneling endoscopic resection-related adverse events in a standardized lexicon a large volume of 1701 cases. Surg Endosc 36:1–9

    Article  CAS  Google Scholar 

  25. Hu J, Liu W, Chen Z et al (2021) A novel snare traction-assisted method during endoscopic resection for upper gastrointestinal submucosal tumors. J Laparoendosc Adv Surg Tech A 31(4):416–422

    Article  PubMed  Google Scholar 

  26. Zhang Q, Cai JQ, Wang Z (2020) Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis. Gastroenterol Rep 9(2):125–132

    Article  CAS  Google Scholar 

  27. Chen T, Lin ZW, Zhang YQ et al (2017) Submucosal tunneling endoscopic resection vs thoracoscopic enucleation for large submucosal tumors in the esophagus and the esophagogastric junction. J Am Coll Surg 225(6):806–816

    Article  PubMed  Google Scholar 

  28. Higuchi K, Goto O, Koizumi E et al (2020) Usefulness of the flexible traction method in gastric endoscopic submucosal dissection: an in-vivo animal study. Surg Endosc 34(12):5632–5639

    Article  PubMed  Google Scholar 

  29. Nagata M (2022) Advances in traction methods for endoscopic submucosal dissection: what is the best traction method and traction direction? World J Gastroenterol 28(1):1–22

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.

Funding

This study received no specific grant from any funding agency including the public, commercial or not-for-profit sectors, et al.

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Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230031, China

    Jinqing Wu & Qiao Mei

  2. Department of Gastroenterology, Fuyang People’s Hospital (Fuyang People’s Hospital Affiliated to Anhui Medical University), Fuyang, 236000, China

    Jinqing Wu & Guizhou Wang

Authors
  1. Jinqing Wu
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  2. Guizhou Wang
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  3. Qiao Mei
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Corresponding authors

Correspondence to Guizhou Wang or Qiao Mei.

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Disclosures

Jinqing Wu, Guizhou Wang, and Qiao Mei have no conflicts of interest or financial ties to disclose.

Ethical approval

This a single-center, single-blind, randomized controlled study. All subjects provided written informed consent before STER.The IRB of Fuyang people’s hospital approval was obtained for this prospective study. All procedures performed in studies involving patients were in accordance with the ethical standards of the institutional or/and national research committee and with the 1964 Helsinki Declaration.

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Wu, J., Wang, G. & Mei, Q. Efficacy and safety of esophageal submucosal tumors treated with internal traction method-assisted submucosal tunneling endoscopic resection: a single-center, single-blind, randomized controlled study. Surg Endosc 37, 2873–2884 (2023). https://doi.org/10.1007/s00464-022-09813-7

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  • DOI: https://doi.org/10.1007/s00464-022-09813-7

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