Double Channel ESD method using EEMR-tube for superficial carcinoma of the esophagus

Abstract

ESD was performed for 118 cases of superficial esophageal carcinoma (144 lesions) . Of the cases, 110 lesions (76.4%) were treated using the double channel (DC) ESD with the Clutch Cutter and an EEMR-tube. En bloc resection was possible in 100% of the cases, which prevented bleeding. However, perforation occurred in 2 cases (1.3%) , which were treated conservatively. The DC method with the EEMR-tube did not cause any perforations. Complete resection was performed in 95.8% of cases without local recurrence or metastasis. The DC method with the EEMR-tube allows for countertraction by grasping the cut end with fine V-shaped forceps through the side channel. This method allows endoscopists to 1) create a better operative field, 2) maintain a good stable view, 3) change the retraction direction by rotating the EEMR-tube, 4) alter the retraction point during the procedure, 5) avoid interrupting the procedure by alternating between the forceps and the devices, 6) easily detect vascular structure and stop bleeding. The procedure should be performed under general anesthesia in an operating room to avoid respiratory complications and limit the stress on endoscopists.