Published online Sep 21, 2018. doi: 10.3748/wjg.v24.i35.4077
Peer-review started: June 21, 2018
First decision: July 31, 2018
Revised: August 5, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: September 21, 2018
To prospectively investigate the efficacy and safety of clip-flap assisted endoscopic submucosal dissection (ESD) for gastric tumors.
From May 2015 to October 2016, we enrolled 104 patients with gastric cancer or adenoma scheduled for ESD at Shiga University of Medical Science Hospital. We randomized patients into two subgroups using the minimization method based on location of the tumor (upper, middle or lower third of the stomach), tumor size (< 20 mm or > 20 mm) and ulcer status: ESD using an endoclip (the clip-flap group) and ESD without an endoclip (the conventional group). Therapeutic efficacy (procedure time) and safety (complication: Gastrointestinal bleeding and perforation) were assessed.
En bloc resection was performed in all patients. Four patients had delayed bleeding (3.8%) and two had perforation (1.9%). No significant differences in en bloc resection rate (conventional group: 100%, clip flap group: 100%), curative endoscopic resection rate (conventional group: 90.9%, clip flap group: 89.8%, P = 0.85), procedure time (conventional group: 70.8 ± 46.2 min, clip flap group: 74.7 ± 53.3 min, P = 0.69), area of resected specimen (conventional group: 884.6 ± 792.1 mm2, clip flap group: 1006.4 ± 1004.8 mm2, P = 0.49), delayed bleeding rate (conventional group: 5.5%, clip flap group: 2.0%, P = 0.49), or perforation rate (conventional group: 1.8%, clip flap group: 2.0%, P = 0.93) were found between the two groups. Less-experienced endoscopists did not show any differences in procedure time between the two groups.
For patients with early-stage gastric tumors, the clip-flap method has no advantage in efficacy or safety compared with the conventional method.
Core tip: We conducted a prospective study to investigate efficacy of the clip-flap method of endoscopic submucosal dissection (ESD) for early-stage gastric tumor. Recently, although the efficacy of the clip-flap method for ESD of large colorectal tumors is shown, we failed to show advantage of clip-flap method in efficacy or safety compared with the conventional method. Efficacy of clip-flap method-assisted ESD for gastric tumors may be limited, especially in cases with large size of tumor and with difficulty to make mucosal flap.