Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2018; 24(15): 1632-1640
Published online Apr 21, 2018. doi: 10.3748/wjg.v24.i15.1632
Endoscopic submucosal dissection for early esophageal neoplasms using the stag beetle knife
Toshio Kuwai, Toshiki Yamaguchi, Hiroki Imagawa, Ryoichi Miura, Yuki Sumida, Takeshi Takasago, Yuki Miyasako, Tomoyuki Nishimura, Sumio Iio, Atsushi Yamaguchi, Hirotaka Kouno, Hiroshi Kohno, Sauid Ishaq
Toshio Kuwai, Toshiki Yamaguchi, Hiroki Imagawa, Ryoichi Miura, Yuki Sumida, Takeshi Takasago, Yuki Miyasako, Tomoyuki Nishimura, Sumio Iio, Atsushi Yamaguchi, Hirotaka Kouno, Hiroshi Kohno, Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure 737-0023, Japan
Sauid Ishaq, Department of Gastroenterology, DGH, SGU, WI, Birmingham City University, Birmingham B4 7BD, United Kingdom
Author contributions: Kuwai T designed the research; Yamaguchi T, Imagawa H, Yamaguchi A, Kouno H, Kohno H and Ishaq S contributed by providing critical intellectual input for the revised manuscript; Kuwai T, Miura R, Sumida Y, Takasago T, Miyasako Y, Nishimura T and Iio S analyzed the data; Kuwai T wrote the article.
Institutional review board statement: This study was approved by the National Hospital Organization Kure Medical Center and the Chugoku Cancer Center Institutional Review Board Ethics Committee on 3 October 2016, the study incorporated good clinical practice, conforming to Declaration of Helsinki principles.
Informed consent statement: All patients were informed of the risks and benefits of ESD and provided written informed consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
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: Toshio Kuwai, MD, PhD, Chief Doctor, Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama-cho, Kure 737-0023, Japan. kuwait@kure-nh.go.jp
Telephone: +81-823-223111 Fax: +81-823-210478
Received: February 9, 2018
Peer-review started: February 11, 2018
First decision: March 9, 2018
Revised: March 16, 2018
Accepted: March 31, 2018
Article in press: March 30, 2018
Published online: April 21, 2018
Processing time: 68 Days and 19.7 Hours
Abstract
AIM

To determine short- and long-term outcomes of endoscopic submucosal dissection (ESD) using the stag beetle (SB) knife, a scissor-shaped device.

METHODS

Seventy consecutive patients with 96 early esophageal neoplasms, who underwent ESD using a SB knife at Kure Medical Center and Chugoku Cancer Center, Japan, between April 2010 and August 2016, were retrospectively evaluated. Clinicopathological characteristics of lesions and procedural adverse events were assessed. Therapeutic success was evaluated on the basis of en bloc, histologically complete, and curative or non-curative resection rates. Overall and tumor-specific survival, local or distant recurrence, and 3- and 5-year cumulative overall metachronous cancer rates were also assessed.

RESULTS

Eligible patients had dysplasia/intraepithelial neoplasia (22%) or early cancers (squamous cell carcinoma, 78%). The median procedural time was 60 min and on average, the lesions measured 24 mm in diameter, yielding 33-mm tissue defects. The en bloc resection rate was 100%, with 95% and 81% of dissections deemed histologically complete and curative, respectively. All procedures were completed without accidental incisions/perforations or delayed bleeding. During follow-up (mean, 35 ± 23 mo), no local recurrences or metastases were observed. The 3- and 5-year survival rates were 83% and 70%, respectively, with corresponding rates of 85% and 75% for curative resections and 74% and 49% for non-curative resections. The 3- and 5-year cumulative rates of metachronous cancer in the patients with curative resections were 14% and 26%, respectively.

CONCLUSION

ESD procedures using the SB knife are feasible, safe, and effective for treating early esophageal neoplasms, yielding favorable short- and long-term outcomes.

Keywords: Neoplasms; Stag beetle knife; Esophageal; Endoscopic submucosal dissection; Outcome measures

Core tip: Various devices designed for endoscopic submucosal dissection (ESD) are currently under investigation for their usefulness in the treatment of early esophageal neoplasms. This study aimed to evaluate the short- and long-term outcomes of ESD using the stag beetle (SB) knife, a scissor-shaped device. Seventy-four patients with 101 esophageal lesions underwent resection via SB-knife ESD. Rates of en bloc, histologically complete, and curative resections were 100%, 95%, and 81%, respectively. The 3- and 5-year survival rates were 83% and 70%, respectively. The SB knife allows safe and effective ESD of early esophageal neoplasms.