הערכת יעילות החתך האורכי לחפירה תת-רירית אנדוסקופית של נגעים תת-אפיתליים בקיבה

Overview

This article details a protocol for longitudinal incision endoscopic submucosal excavation (ESE) as an improved method for removing small gastric subepithelial lesions (SELs ≤ 2 cm). The longitudinal incision technique is compared to the conventional circular incision, demonstrating advantages in operative efficiency, defect closure, and safety.

Key Study Components

Area of Science

• Gastroenterology
• Endoscopic surgery
• Minimally invasive procedures

Background

• Endoscopic submucosal excavation (ESE) is used to manage gastric subepithelial lesions.
• Traditional circular incisions can create large defects that are difficult to close.
• Efficient closure and reduced operative time are important for patient outcomes.
• There is a need for improved techniques to optimize ESE for small gastric SELs.

Purpose of Study

• To present a detailed protocol for longitudinal incision ESE.
• To compare the longitudinal incision technique with the conventional circular incision in terms of procedural success, operative time, and safety.
• To assess the feasibility and technical outcomes of the new approach.

Methods Used

• Marking the lesion margin with dots in a circular pattern, 3–5 mm outside the lesion edge.
• Submucosal injection of indigo rouge to elevate the mucosa.
• Making a longitudinal incision along the central axis of the lesion using an electrosurgical knife.
• Dissecting and separating submucosal tissue to fully expose and free the lesion.
• Hemostasis using electrosurgical knife and hemostatic forceps as needed.
• Primary closure of the defect with sequential application of metal clips under suction.
• Retrospective comparison of outcomes between longitudinal (n=21) and circular (n=31) incision groups.

Main Results

• The longitudinal incision group achieved a 100% procedural success rate.
• Mean operation time was significantly shorter for the longitudinal group (51.43 ± 5.56 min) compared to the circular group (70.00 ± 6.96 min, P=0.0179).
• Reduced need for advanced closure devices in the longitudinal group (5% vs. 28%).
• Low complication rates in both groups, with no serious postoperative events.

Conclusions

• The longitudinal incision ESE technique is safe, effective, and feasible for gastric SELs ≤ 2 cm.
• This method offers practical advantages in operative efficiency and defect management.
• It may reduce the need for additional closure devices and consumables.

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