An innovative technique for endoscopic submucosal dissection of early gastric cancer using a new spring device.
OBJECTIVE
In recent years, endoscopic submucosal dissection (ESD) has been applied for the treatment of gastric tumors, and the en-bloc resection rate of early gastric cancer has greatly improved. Herein, we introduce spring-assisted ESD, for quicker submucosal dissection.


METHODS
ESD was carried out in 32 patients (20 men, 12 women; mean age 72.6 years, range 53 - 88 years) for early gastric cancer, with tumors over 10 mm in diameter. The patients were divided retrospectively into two groups (spring-assisted ESD, n = 20; conventional ESD, n = 12). To comparatively evaluate the performance speed of ESD, the circumferential length and the area of the resected specimen were calculated by the approximation formula for ellipse. Then, the circumferential cutting speed, the submucosal dissection speed, and the total ESD speed were calculated as index scores. The scores for spring-assisted ESD and conventional ESD were compared.


RESULTS
The mean (+/-SD) circumferential cutting speeds in spring-assisted ESD and conventional ESD were 0.53 +/- 0.27 and 0.60 +/- 0.30 cm/minute, respectively ( P = 0.51). The mean submucosal dissection speeds in spring-assisted ESD and conventional ESD were 0.67 +/- 0.41 and 0.32 +/- 0.24 cm (2)/minute, respectively ( P = 0.005). The mean total ESD speeds in spring-assisted ESD and conventional ESD were 0.25 +/- 0.10 and 0.17 +/- 0.07 cm (2)/minute, respectively ( P = 0.015). The mean total ESD times were 57 and 75 minutes in the spring and conventional group, respectively ( P = 0.30).


CONCLUSIONS
Using the aforementioned indices, we evaluated the performance speed of ESD. Spring-assisted ESD may allow faster submucosal dissection.
Department of Surgery, Nippon Medical School, Tokyo 113-8603, Japan. nsakuraz@nms.ac.jp
N
N
Sakurazawa
S
S
Kato
M
M
Miyashita
T
T
Kiyama
I
I
Fujita
N
N
Yamashita
Y
Y
Saitou
T
T
Tajiri
E
E
Uchida
D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D020699:Gastroscopes; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome