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[Application of dental floss traction-assisted endoscopic submucosa dissection to rectal neuroendocrine neoplasm].
Zhonghua Wei Chang Wai Ke Za Zhi 2019; 22(4):377-382ZW

Abstract

Objective:

To evaluate the safety and efficacy of dental floss traction-assisted endoscopic submucosal dissection (DFS-ESD) for rectal neuroendocrine neoplasm (NEN).

Methods:

A retrospective cohort study was performed. Clinical data of rectal NEN patients undergoing ESD at Endoscopy Center of Zhongshan Hospital, Fudan University from January 2016 to December 2017 were retrospectively analyzed. Inclusion criteria: 1) age of 18 to 80 years old; 2) maximal diameter of lesions <1.5 cm; 3) tumor locating in the submucosa without invasion into the muscularis propria; 4) no enlarged lymph nodes around bowel and in abdominal cavity; 5) ESD requested actively by patients. A total of 37 patients were enrolled, including 23 male and 14 female cases with mean age of (56.0±11.3) years. All the lesions were single tumor of stage T1, and the mean size was 0.8±0.2(0.5-1.2) cm. Postoperative pathology revealed all samples as neuroendocrine tumors (NET). Seventeen patients received DFS-ESD treatment (DFS-ESD group) and 20 patient received conventional ESD treatment (conventional ESD group). In DFS-ESD group, after the mucosa was partly incised along the marker dots, the endoscopy was extracted, and the dental floss was tied to one arm of the metallic clip. When the endoscope was reinserted, the hemoclip was attached onto the incised mucosa; another hemoclip was attached onto normal mucosa opposite to the lesion in the same way. The submucosa was clearly exposed with the traction of dental floss and the resection could proceed. The conventional ESD group received the traditional ESD operation procedure. The operation time, modified operation time (remaining time after excluding the assembly time of dental floss traction in DFS-ESD group), en bloc resection rate, R0 resection rate, morbidity of operative complication, recurrence and metastasis were compared between two groups.

Results:

The average tumor size was (0.8±0.2) cm in DFS-ESD group and (0.7±0.2) cm in conventional ESD group (t=0.425, P=0.673). According to postoperative pathological grading of rectal neuroendocrine neoplasm, 13 were G1 and 4 were G2 in DFS-ESD group, while 17 cases were G1 and 3 cases were G2 in conventional ESD group without significant difference (P=0.680). There were no significant differences in baseline data between in the two groups (all P>0.05). All the basal resection margins were negative, the en bloc resection rate was 100% and the R0 resection rate was 100%. Pathological results showed tumor tissue close to the burning margin in 5 cases of conventional ESD group and in 2 cases of DFS-ESD group (P=0.416). The operation time was (17.9±6.6) minutes in conventional ESD group and (14.7±3.3) minutes in DFS-ESD group (t=1.776, P=0.084). The modified operation time of DFS-ESD group was (11.9±2.8) minutes, which was significantly shorter than (17.9±6.6) minutes in conventional ESD group (t=3.425, P=0.002). The hospital stay was (2.3±0.6) days and (2.0±0.5) days in conventional ESD group and DFS-ESD group, respectively, without significant difference (t=1.436, P=0.160). No patient was transferred to surgery, and no delayed bleeding or perforation occurred in either group. There was no recurrence or primary tumor-related death, and all the patients recovered well during a follow-up period of 14(1-24) months.

Conclusion:

Dental floss traction-assisted ESD for rectal neuroendocrine neoplasm can simplify operation and ensure negative basal margin.

Authors+Show Affiliations

Department of Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China Zhang Hao and Yong Yuanyuan are now working in Department of Endoscopy Center, People's Hospital of Chaya, Changdu, Tibet 854300, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

chi

PubMed ID

31054553

Citation

Shi, Q, et al. "[Application of Dental Floss Traction-assisted Endoscopic Submucosa Dissection to Rectal Neuroendocrine Neoplasm]." Zhonghua Wei Chang Wai Ke Za Zhi = Chinese Journal of Gastrointestinal Surgery, vol. 22, no. 4, 2019, pp. 377-382.
Shi Q, Sun D, Zhong YS, et al. [Application of dental floss traction-assisted endoscopic submucosa dissection to rectal neuroendocrine neoplasm]. Zhonghua Wei Chang Wai Ke Za Zhi. 2019;22(4):377-382.
Shi, Q., Sun, D., Zhong, Y. S., Xu, M. D., Li, B., Cai, S. L., ... Zhou, P. H. (2019). [Application of dental floss traction-assisted endoscopic submucosa dissection to rectal neuroendocrine neoplasm]. Zhonghua Wei Chang Wai Ke Za Zhi = Chinese Journal of Gastrointestinal Surgery, 22(4), pp. 377-382. doi:10.3760/cma.j.issn.1671-0274.2019.04.011.
Shi Q, et al. [Application of Dental Floss Traction-assisted Endoscopic Submucosa Dissection to Rectal Neuroendocrine Neoplasm]. Zhonghua Wei Chang Wai Ke Za Zhi. 2019 Apr 25;22(4):377-382. PubMed PMID: 31054553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Application of dental floss traction-assisted endoscopic submucosa dissection to rectal neuroendocrine neoplasm]. AU - Shi,Q, AU - Sun,D, AU - Zhong,Y S, AU - Xu,M D, AU - Li,B, AU - Cai,S L, AU - Qi,Z P, AU - Ren,Z, AU - Zhang,H, AU - Yong,Y Y, AU - Yao,L Q, AU - Zhou,P H, PY - 2019/5/6/entrez PY - 2019/5/6/pubmed PY - 2019/6/27/medline KW - Dental floss traction KW - Endoscopic submucosal dissection KW - Neuroendocrine neoplasm, rectum SP - 377 EP - 382 JF - Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery JO - Zhonghua Wei Chang Wai Ke Za Zhi VL - 22 IS - 4 N2 - Objective: To evaluate the safety and efficacy of dental floss traction-assisted endoscopic submucosal dissection (DFS-ESD) for rectal neuroendocrine neoplasm (NEN). Methods: A retrospective cohort study was performed. Clinical data of rectal NEN patients undergoing ESD at Endoscopy Center of Zhongshan Hospital, Fudan University from January 2016 to December 2017 were retrospectively analyzed. Inclusion criteria: 1) age of 18 to 80 years old; 2) maximal diameter of lesions <1.5 cm; 3) tumor locating in the submucosa without invasion into the muscularis propria; 4) no enlarged lymph nodes around bowel and in abdominal cavity; 5) ESD requested actively by patients. A total of 37 patients were enrolled, including 23 male and 14 female cases with mean age of (56.0±11.3) years. All the lesions were single tumor of stage T1, and the mean size was 0.8±0.2(0.5-1.2) cm. Postoperative pathology revealed all samples as neuroendocrine tumors (NET). Seventeen patients received DFS-ESD treatment (DFS-ESD group) and 20 patient received conventional ESD treatment (conventional ESD group). In DFS-ESD group, after the mucosa was partly incised along the marker dots, the endoscopy was extracted, and the dental floss was tied to one arm of the metallic clip. When the endoscope was reinserted, the hemoclip was attached onto the incised mucosa; another hemoclip was attached onto normal mucosa opposite to the lesion in the same way. The submucosa was clearly exposed with the traction of dental floss and the resection could proceed. The conventional ESD group received the traditional ESD operation procedure. The operation time, modified operation time (remaining time after excluding the assembly time of dental floss traction in DFS-ESD group), en bloc resection rate, R0 resection rate, morbidity of operative complication, recurrence and metastasis were compared between two groups. Results: The average tumor size was (0.8±0.2) cm in DFS-ESD group and (0.7±0.2) cm in conventional ESD group (t=0.425, P=0.673). According to postoperative pathological grading of rectal neuroendocrine neoplasm, 13 were G1 and 4 were G2 in DFS-ESD group, while 17 cases were G1 and 3 cases were G2 in conventional ESD group without significant difference (P=0.680). There were no significant differences in baseline data between in the two groups (all P>0.05). All the basal resection margins were negative, the en bloc resection rate was 100% and the R0 resection rate was 100%. Pathological results showed tumor tissue close to the burning margin in 5 cases of conventional ESD group and in 2 cases of DFS-ESD group (P=0.416). The operation time was (17.9±6.6) minutes in conventional ESD group and (14.7±3.3) minutes in DFS-ESD group (t=1.776, P=0.084). The modified operation time of DFS-ESD group was (11.9±2.8) minutes, which was significantly shorter than (17.9±6.6) minutes in conventional ESD group (t=3.425, P=0.002). The hospital stay was (2.3±0.6) days and (2.0±0.5) days in conventional ESD group and DFS-ESD group, respectively, without significant difference (t=1.436, P=0.160). No patient was transferred to surgery, and no delayed bleeding or perforation occurred in either group. There was no recurrence or primary tumor-related death, and all the patients recovered well during a follow-up period of 14(1-24) months. Conclusion: Dental floss traction-assisted ESD for rectal neuroendocrine neoplasm can simplify operation and ensure negative basal margin. SN - 1671-0274 UR - https://www.unboundmedicine.com/medline/citation/31054553/[Application_of_dental_floss_traction_assisted_endoscopic_submucosa_dissection_to_rectal_neuroendocrine_neoplasm]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&amp;issn=1671-0274&amp;year=2019&amp;vol=22&amp;issue=4&amp;fpage=377 DB - PRIME DP - Unbound Medicine ER -