A new technique for pharyngeal endoscopic submucosal dissection: peroral countertraction (with video)

Abstract

Background: Endoscopic submucosal dissection (ESD) can be used to perform resections en bloc for early-stage GI tumors. Pharyngeal ESD is less invasive, but technically difficult. Therefore, innovations to safely and easily perform this procedure are needed.

Objective: The aim of this study was to evaluate ESD under peroral countertraction, a new traction system for improving subepithelial cutting line visualization, compared with conventional ESD.

Design: Retrospective study.

Setting: Toranomon Hospital, Tokyo, Japan.

Patients: A total of 93 patients (140 lesions) with superficial pharyngeal cancers treated with ESD were enrolled.

Interventions: ESD under peroral countertraction or conventional ESD.

Main outcome measurements: En bloc resection rate, size of the tumor, and procedure time.

Results: All lesions were resected en bloc by using this technique. The mean longest lesion size was 23.4 mm in the peroral countertraction group and 18.1 mm in the conventional group (P = .038). The mean procedure time did not differ between the 2 groups. Subcutaneous emphysema as an adverse event was observed in the conventional ESD group. No treatment-related adverse events occurred in the peroral countertraction group.

Limitations: Retrospective comparison.

Conclusions: ESD under peroral countertraction is easier and appears to be safer for completely removing superficial mesopharyngeal and hypopharyngeal cancers.