Published online Mar 14, 2017. doi: 10.3748/wjg.v23.i10.1843
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
Processing time: 155 Days and 20.9 Hours
To compare the efficacy and safety of a hook knife (HO) with a hybrid knife (HK) during endoscopic submucosal tunnel dissection (ESTD) procedure.
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.
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.
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.