Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Endoscopic submucosal tunnel dissection of upper gastrointestinal submucosal tumors: A comparative study of hook knife vs hybrid knife
Jie-Qiong Zhou, Xiao-Wei Tang, Yu-Tang Ren, Zheng-Jie Wei, Si-Lin Huang, Qiao-Ping Gao, Xiao-Feng Zhang, Jian-Feng Yang, Wei Gong, Bo Jiang
Jie-Qiong Zhou, Si-Lin Huang, Qiao-Ping Gao, Wei Gong, Bo Jiang, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Jie-Qiong Zhou, Yu-Tang Ren, Zheng-Jie Wei, Bo Jiang, Department of Gastroenterology, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing 102218, China
Xiao-Wei Tang, Xiao-Feng Zhang, Jian-Feng Yang, Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Zhou JQ and Tang XW contributed equally to this work; Zhou JQ, Tang XW and Jiang B designed the research; Ren YT and Gong W performed the research; Wei ZJ, Huang SL, Gao QP, Zhang XF and Yang JF analyzed the data; Gong W and Jiang B supervised the study; Zhou JQ and Tang XW wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Nanfang Hospital, Guangzhou, China.
Informed consent statement: All patients provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declared that there are no conflicts of interest in this study.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at drjiang@163.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Bo Jiang, Professor, Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No.1838, Guangzhou North Ave, Guangzhou 510515, Guangdong Province, China. drjiang@163.com
Telephone: +86-20-61641888 Fax: +86-20-61641541
Received: October 8, 2016
Peer-review started: October 11, 2016
First decision: November 21, 2016
Revised: December 18, 2016
Accepted: January 18, 2017
Article in press: January 18, 2017
Published online: March 14, 2017
AIM
To compare the efficacy and safety of a hook knife (HO) with a hybrid knife (HK) during endoscopic submucosal tunnel dissection (ESTD) procedure.
METHODS
Between August 2012 and December 2015, the ESTD procedure was performed for 83 upper GI submucosal lesions, which originated from the muscularis propria layer identified by upper endoscopy and endoscopic ultrasonography. Of these, 34 lesions were treated by a HO, whereas 49 lesions were treated by a HK. Data regarding age, gender, presenting symptoms, tumor location and size, procedure time, complications, en bloc resection rate and others were analyzed and compared between the two groups.
RESULTS
There were no significant differences in the age, gender, presenting symptoms and tumor location between the two groups. ESTD was successfully completed in all the patients, and no case was converted to laparoscopy. The mean procedure time was significantly shorter in the HK group than in the HO group (41.3 ± 20.3 min vs 57.2 ± 28.0 min, P = 0.004). The mean frequency of device exchange was 1.4 ± 0.6 in the HK group and significantly less than 3.3 ± 0.6 in the HO group (P < 0.001). The differences in tumor size and histopathological diagnoses were not significant between the two groups (P = 0.813, P = 0.363, respectively). Both groups had an equal en bloc resection rate and complete resection rate. Additionally, the complication rate was similar between the two groups (P = 0.901). During the follow-up, no recurrence occurred in either group.
CONCLUSION
We demonstrate for the first time that HO and HK do not differ in efficacy or safety, but HK reduces the frequency of device exchange and procedure time.
Core tip: Settings for the endoscopic submucosal tunnel dissection (ESTD) procedure have not been standardized, and no studies have directly compared ESTD devices in humans. We compared the performance between hook knife (HO) and hybrid knife (HK) in the ESTD procedure for upper gastrointestinal submucosal tumors. Our study demonstrated for the first time that HO and HK do not differ in terms of efficacy or complication rates during ESTD procedure, but HK can significantly reduce the frequency of device exchange and procedure time.
