Feasibility of electrocautery snaring as the final step of endoscopic submucosal dissection for stomach epithelial neoplasms.
BACKGROUND
Endoscopic submucosal dissection (ESD) is a novel endoluminal technique that permits the resection of gastric neoplasms.


OBJECTIVE
To analyse the feasibility of snaring as the final step of ESD.


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 (< or = 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.
Goto
O
O
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Fujishiro
M
M
Kodashima
S
S
Kakushima
N
N
Ono
S
S
Yahagi
N
N
Omata
M
M
D000368:Aged; D004210:Dissection / Q000379:methods*; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome