Shi D, Zheng L. Synergistic effect of Codonopsis lanceolata and clip-line traction in endoscopic submucosal dissection for early esophageal cancer. World J Gastrointest Surg 2026; 18(6): 117856 [DOI: 10.4240/wjgs.117856]
Corresponding Author of This Article
Liang Zheng, Chief Physician, Department of Gastroenterology, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No. 23 Nanhu Road, Jiandu District, Nanjing 210000, Jiangsu Province, China. sd479324634@163.com
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Gastroenterology & Hepatology
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Shi D, Zheng L. Synergistic effect of Codonopsis lanceolata and clip-line traction in endoscopic submucosal dissection for early esophageal cancer. World J Gastrointest Surg 2026; 18(6): 117856 [DOI: 10.4240/wjgs.117856]
World J Gastrointest Surg. Jun 27, 2026; 18(6): 117856 Published online Jun 27, 2026. doi: 10.4240/wjgs.117856
Synergistic effect of Codonopsis lanceolata and clip-line traction in endoscopic submucosal dissection for early esophageal cancer
Dai Shi, Liang Zheng
Dai Shi, Department of Infectious Diseases, The Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi 214000, Jiangsu Province, China
Liang Zheng, Department of Gastroenterology, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China.
Author contributions: Shi D contributed to data collection and paper writing; Shi D and Zheng L contributed to research design, data analysis; Zheng L was responsible for funding application, reviewing and editing, communication coordination, ethical review, copyright and licensing, and follow-up. All author approval the final manuscript.
Institutional review board statement: The research was reviewed and approved by the Wuxi Traditional Chinese Medicine Hospital (Approval No. 2025-585).
Clinical trial registration statement: This prospective randomized controlled trial was initiated in early 2023, during the transitional period of mandatory clinical trial registration policy at our hospital. The registration process for studies on traditional Chinese medicine as an adjunct therapy was not yet fully standardized, and administrative delays prevented us from completing prospective registration before patient enrollment.
Informed consent statement: All research participants or their legal guardians provided written informed consent prior to study registration.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: I have read the CONSORT 2010 statement and the manuscript has been written and revised based on the CONSORT 2010 statement.
Data sharing statement: No other data available.
Corresponding author: Liang Zheng, Chief Physician, Department of Gastroenterology, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No. 23 Nanhu Road, Jiandu District, Nanjing 210000, Jiangsu Province, China. sd479324634@163.com
Received: January 20, 2026 Revised: February 6, 2026 Accepted: March 10, 2026 Published online: June 27, 2026 Processing time: 151 Days and 15.9 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) is an effective minimally invasive treatment for early esophageal cancer, but it induces significant postoperative inflammation, pain, delayed recovery, and risk of esophageal stricture. Taishan Codonopsis (Codonopsis lanceolata Benth. et Hook. f.), a traditional Chinese herb rich in saponins and polysaccharides, exhibits anti-inflammatory and tissue-repair properties. We hypothesized that perioperative administration of Taishan Codonopsis combined with clipping wire traction-assisted ESD would enhance recovery by mitigating systemic inflammation and promoting ulcer healing.
AIM
To evaluate the effect of Taishan Codonopsis on outcomes after clip-line traction-assisted ESD.
METHODS
This single-center, randomized controlled trial enrolled 100 patients with early esophageal cancer at Jiangsu Second Traditional Chinese Medicine Hospital (January 2023-December 2024). Patients were randomly assigned to clipping wire traction-assisted ESD alone or ESD plus oral Taishan Codonopsis extract (250 mg three times daily) from 7 days preoperatively to 14 days postoperatively (n = 50 per group). Between-group comparisons used independent-samples t-tests or χ2 tests; statistical significance was defined as P < 0.05.
RESULTS
There were no significant differences in baseline characteristics or procedural efficiency between the two groups. C-reactive protein levels in the combination group were significantly lower than those in the clipping wire traction group on postoperative day 1, day 3, and day 7 (P < 0.001). Compared with the clipping wire traction group, the combination group exhibited lower peak postoperative pain (P < 0.001), earlier time to first meal (P < 0.001), and shorter postoperative hospital stays (P < 0.001). Four weeks after surgery, gastroscopic reexamination revealed that the ulcer healing rates in the combination group (90.0%) was significantly higher than that in the clipping wire traction group (64.0%; P < 0.05).
CONCLUSION
Perioperative Taishan Codonopsis significantly suppresses post-ESD inflammation, accelerates recovery, and improves ulcer healing when combined with clipping wire traction-assisted ESD, offering a valuable adjunct to endoscopic resection.
