title: The "tunnel + clip" strategy standardised and facilitates oesophageal ESD procedures: a prospective, consecutive bi-centric study.
abstract: ESD is the treatment of choice for superficial neoplasms of the oesophagus; ESD is oncologically efficient and associated with less morbidity than the surgical alternative. ESD requires a high level of skill, being both technically challenging and time consuming. Therefore, ESD is often reserved for experts. A combination of a tunnel technique with clip-line traction may enable optimisation of oesophageal ESD.
  
  
  
  From January 2015 to December 2016, we performed a prospective two-centre case study of consecutive "tunnel + clip" oesophageal ESD. Four young operators (each of whom had performed fewer than 50 ESDs and fewer than five oesophageal ESDs) treated patients requiring ESD using the tunnel + clip method. This involves generation of a classic tunnel beneath the lesion, with constant traction being applied by a clip with a line placed at the oral side of the tunnel.
  
  
  
  Sixty-two lesions (25 SCCs and 34 ADK/HGDs complicating Barrett's oesophagus) were consecutively resected. The en bloc, R0, and curative resection rates were 100% (62/62), 88.7% (55/62), and 74.2% (46/62), respectively. No perforation was noted. The mean ESD velocity was 24.5 mm2/min for lesions of mean length 59.6 mm. The tunnel + clip approach greatly aided the procedure. No pathological damage caused by clipping was evident.
  
  
  
  Use of the tunnel + clip strategy to treat oesophageal ESD is effective and safe, even when performed by physicians with little prior experience. It is thus possible to standardise ESD of superficial oesophageal neoplasms and increase the velocity of dissection. Our procedure will encourage the use of oesophageal ESD in Western countries.
authors.affiliation: Service d'hépato-gastro-entérologie, CHU Dupuytren, 2 avenue Martin Luther-King, 87042, Limoges, France. jeremiejacques@gmail.com.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Jacques
authors.affiliation: Service d'hépato-gastro-entérologie, CHU Dupuytren, 2 avenue Martin Luther-King, 87042, Limoges, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Legros
authors.affiliation: Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices civils de lyon, 5 place d'Arsonval, 69003, Lyon, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Rivory
authors.affiliation: Service d'anatomopathologie, CHU Dupuytren, 2 avenue Martin Luther-King, 87042, Limoges, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Charissoux
authors.affiliation: Service d'hépato-gastro-entérologie, CHU Dupuytren, 2 avenue Martin Luther-King, 87042, Limoges, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Sautereau
authors.affiliation: Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices civils de lyon, 5 place d'Arsonval, 69003, Lyon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.affiliation: Service d'hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices civils de lyon, 5 place d'Arsonval, 69003, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pioche
mesh_terms: D000368:Aged; D001471:Barrett Esophagus / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D000069916:Endoscopic Mucosal Resection / Q000295:instrumentation* / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D004945:Esophagoscopy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome
keywords: Clip with line; Countertraction; Oesophageal ESD; Tunnel ESD