A new technique for pharyngeal endoscopic submucosal dissection: peroral countertraction (with video).
BACKGROUND
Endoscopic submucosal dissection (ESD) can be used to perform resections en bloc for early-stage GI tumors. Pharyngeal ESD is less invasive, but technically difficult. Therefore, innovations to safely and easily perform this procedure are needed.


OBJECTIVE
The aim of this study was to evaluate ESD under peroral countertraction, a new traction system for improving subepithelial cutting line visualization, compared with conventional ESD.


METHODS
Retrospective study.


METHODS
Toranomon Hospital, Tokyo, Japan.


METHODS
A total of 93 patients (140 lesions) with superficial pharyngeal cancers treated with ESD were enrolled.


METHODS
ESD under peroral countertraction or conventional ESD.


METHODS
En bloc resection rate, size of the tumor, and procedure time.


RESULTS
All lesions were resected en bloc by using this technique. The mean longest lesion size was 23.4 mm in the peroral countertraction group and 18.1 mm in the conventional group (P = .038). The mean procedure time did not differ between the 2 groups. Subcutaneous emphysema as an adverse event was observed in the conventional ESD group. No treatment-related adverse events occurred in the peroral countertraction group.


CONCLUSIONS
Retrospective comparison.


CONCLUSIONS
ESD under peroral countertraction is easier and appears to be safer for completely removing superficial mesopharyngeal and hypopharyngeal cancers.
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Toshiro
T
Iizuka
Daisuke
D
Kikuchi
Shu
S
Hoteya
Hidehiko
H
Takeda
Mitsuru
M
Kaise
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D061646:Operative Time; D010610:Pharyngeal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013352:Subcutaneous Emphysema / Q000209:etiology