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  • Title: Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD.
    Author: Goda Y, Mori H, Kobara H, Masaki T.
    Journal: Minim Invasive Ther Allied Technol; 2018 Dec; 27(6):327-332. PubMed ID: 29764299.
    Abstract:
    Background: Duodenal ESD is considered especially difficult with perforation and bleeding. This study assessed safer duodenal ESD procedures, especially with regard to obtaining a good operation view using a ring-thread method and closure of a post-ESD artificial ulcer. Methods: From 2013 to 2015, 17 patients who were diagnosed with duodenal adenoma or early duodenal cancer >20 mm in diameter underwent conventional ESD (C group). From 2016 to 2017, 12 patients underwent ring-shaped thread counter traction ESD with hemoclips and/or Over-The-Scope Clip (OTSC) (Ovesco Endoscopy GmbH, Tuebingen, Germany) closure of post ESD artificial ulcer (ring group). An observational study between the C group and Ring group was conducted. The primary outcome was perforation events during ESD (UMIN000026184). Results: There was a significant difference in perforation during ESD with five cases vs. 0 case in C and ring groups (p = .038). For bleeding that needed to be coagulated by forceps during ESD, there was a significant difference with four cases in the C group (p = .07). The total procedure time was 96.6 ± 28.2 and 72.8 ± 24.2 (min) with a significant difference (p = .027). Conclusions: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.
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