Feasibility of Planned Endoscopic Submucosal Dissection with Snaring for Gastric Adenoma Compared with Standard Endoscopic Submucosal Dissection

ABSTRACT

BACKGROUND/AIMS: Planned endoscopic submucosal dissection with snaring (ESD-S) is thought to shorten operating time spent on submucosal dissection, but may lead to uncertainty of en bloc resection or to a possible increase in tumor-positive margins. The purpose of the present study is to investigate the feasibility of ESD-S as a planned procedure for gastric adenoma. MATERIALS AND METHODS: The medical records of 99 patients who underwent ESD-S or ESD for gastric adenoma between May 2011 and May 2012 were retrospectively reviewed. We analyzed the differences between the ESD-S and the ESD groups, focusing on rates of en bloc resection and pathologic complete resection, mean operation time, and complications. RESULTS: The mean operation time was significantly lower in the ESD-S group than in the ESD group (19.9+/-11.2 vs. 33.8+/-19.9, P=0.012). Cases with an operation time under 30 minutes were more frequent in the ESD-S group (88.9% vs. 48.1%, OR=8.615, 95% CI=2.949~25.168). There were no significant differences in en bloc resection, histologic complete resection, or complication rates between the two groups. CONCLUSIONS: ESD-S has a time advantage over ESD with a comparable compete resection rate. ESD-S can be considered a planned method for available early gastric adenoma.