TY - JOUR
T1 - Endoscopic submucosal dissection with versus without traction for pathologically staged T1B esophageal cancer
T2 - a multicenter retrospective study
AU - Joseph, Abel
AU - Vantanasiri, Kornpong
AU - Draganov, Peter V.
AU - King, William
AU - Maluf-Filho, Fauze
AU - Al-Haddad, Mohammad
AU - Albunni, Hashem
AU - Fukami, Norio
AU - Mohapatra, Sonmoon
AU - Aihara, Hiroyuki
AU - Sharma, Neil R.
AU - Chak, Amitabh
AU - Yang, Dennis
AU - Singh, Rituraj
AU - Jang, Sunguk
AU - Kamath, Suneel
AU - Raja, Siva
AU - Murthy, Sudish
AU - Yang, Qijun
AU - Iyer, Prasad
AU - Bhatt, Amit
N1 - Publisher Copyright:
© 2024 American Society for Gastrointestinal Endoscopy
PY - 2024
Y1 - 2024
N2 - Background and Aims: Positive vertical margins (VMs) are common after endoscopic submucosal dissection (ESD) of T1b esophageal cancer (EC) and are associated with an increased risk of recurrence. Traction during ESD provides better exposure of the submucosa and may allow deeper dissection, potentially reducing the risk of positive VMs. We conducted a retrospective multicenter study to compare the proportion of resections with positive VMs in ESD performed with versus without traction in pathologically staged T1b EC. Methods: Patients who underwent ESD revealing T1b EC (squamous or adenocarcinoma) at 10 academic tertiary referral centers in the United States (n = 9) and Brazil (n = 1) were included. Demographic and clinical data were abstracted. ESD using either traction techniques (tunneling, pocket) or traction devices (clip line, traction wire) were classified as ESD with traction (Tr-ESD) and those without were classified as conventional ESD without traction. The primary outcome was a negative VM. Multivariable logistic regression was used to assess associations with negative VMs. Results: A total of 166 patients with pathologically staged T1b EC underwent Tr-ESD (n = 63; 38%) or conventional ESD without traction (n = 103; 62%). Baseline factors were comparable between both groups. On multivariable analysis, Tr-ESD was found to be independently associated with negative VMs (odds ratio, 2.25; 95% confidence interval, 1.06-4.91; P = .037) and R0 resection (odds ratio, 2.83; 95% confidence interval, 1.33-6.23; P = .008). Conclusion: Tr-ESD seems to be associated with higher odds of negative VMs than ESD without traction for pathologically staged T1b EC, and future well-conducted prospective studies are warranted to establish the findings of the current study.
AB - Background and Aims: Positive vertical margins (VMs) are common after endoscopic submucosal dissection (ESD) of T1b esophageal cancer (EC) and are associated with an increased risk of recurrence. Traction during ESD provides better exposure of the submucosa and may allow deeper dissection, potentially reducing the risk of positive VMs. We conducted a retrospective multicenter study to compare the proportion of resections with positive VMs in ESD performed with versus without traction in pathologically staged T1b EC. Methods: Patients who underwent ESD revealing T1b EC (squamous or adenocarcinoma) at 10 academic tertiary referral centers in the United States (n = 9) and Brazil (n = 1) were included. Demographic and clinical data were abstracted. ESD using either traction techniques (tunneling, pocket) or traction devices (clip line, traction wire) were classified as ESD with traction (Tr-ESD) and those without were classified as conventional ESD without traction. The primary outcome was a negative VM. Multivariable logistic regression was used to assess associations with negative VMs. Results: A total of 166 patients with pathologically staged T1b EC underwent Tr-ESD (n = 63; 38%) or conventional ESD without traction (n = 103; 62%). Baseline factors were comparable between both groups. On multivariable analysis, Tr-ESD was found to be independently associated with negative VMs (odds ratio, 2.25; 95% confidence interval, 1.06-4.91; P = .037) and R0 resection (odds ratio, 2.83; 95% confidence interval, 1.33-6.23; P = .008). Conclusion: Tr-ESD seems to be associated with higher odds of negative VMs than ESD without traction for pathologically staged T1b EC, and future well-conducted prospective studies are warranted to establish the findings of the current study.
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U2 - 10.1016/j.gie.2023.11.047
DO - 10.1016/j.gie.2023.11.047
M3 - Article
C2 - 38042205
AN - SCOPUS:85188458151
SN - 0016-5107
VL - 99
SP - 694
EP - 701
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 5
ER -