Jun-Chao Wu, MD, from the Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, in Sichuan, China discusses this New Methods article, “Endoscopic submucosal multi-tunnel dissection for circumferential superficial esophageal neoplastic lesions (with videos).”
There are some technical challenges endoscopic submucosal tunnel dissection (ESTD) in treating circumferential esophageal neoplastic lesions. Based on the development of ESTD, we report the new technique of endoscopic submucosal multi-tunnel dissection (ESMTD). There were no report about the new technique of endoscopic submucosal multi-tunnel dissection (ESMTD) for circumferential superficial esophageal lesions.
The average length of the resected lesions was 6.1cm. Operating time ranged from 69 minutes to 169 minutes (mean, 121 minutes). En bloc resection was achieved in all lesions, with negative oral, anal, and basal margins on pathology in 2 patients; negative oral and basal margins but positive anal margins of low-grade intraepithelial neoplasia in 1 patient, while the biopsy samples of the positive iodine staining regions at the third gastroscopy after ESTD showed low-grade intraepithelial neoplasia. There were 4 post-ESTD samples that showed high-grade intraepithelial neoplasia in its oral or anal margins while negative basal margins on pathology. These patients had no evidence of recurrence during follow-up（1-12months）. All patients presented with esophageal stricture in 1-3 months after the operation, which was relieved after the retrievable metal stent was placed in 2 cases, and esophageal water balloon dilatation was carried out in 4 cases and the other one did not need esophageal dilatation. Compared with the routine ESTD procedure:
- ESMTD will effectively alleviate the single-tunnel collapse in circumferential lesions so the clear vision field could be maintained during the operation, thus the intraoperative adverse events, such as the bleeding and perforation will be decreased.
- The lateral incision of tunnel wall in ESMTD is easier due to the limited scope of multi-tunnels.
- The number of the tunnels in ESMTD will depend on the extent of the lesion, the thin wall between the tunnels is easier to be incised.
- The tunnel walls in the oral side will be incised finally due to its difficulties.
The next problem was postoperative esophageal stricture after esophageal ESMTD.
Read the article abstract here.
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