Spray and Forced Coagulation Mode Endoscopic Submucosal Dissection for Early Gastric Neoplasms: A Multicenter...

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Controlling intraoperative bleeding is crucial for endoscopic submucosal dissection (ESD) safety.
• Spray coagulation mode (SCM-ESD) may offer superior hemostasis compared to conventional methods.
• Early gastric neoplasms (EGNs) require effective endoscopic treatment.

Purpose of the Study:

• To compare the hemostatic efficacy of SCM-ESD versus forced coagulation mode ESD (FCM-ESD).
• To evaluate SCM-ESD's superiority in controlling bleeding during EGN treatment.
• To assess the impact of SCM-ESD on ESD completion rates and procedural efficiency.

Main Methods:

• A multicenter randomized controlled trial (Spray-G Trial) involving 5 Japanese institutions.
• Patients with intramucosal EGNs were randomized to SCM-ESD or FCM-ESD.
• Primary outcome: ESD completion using only an electrosurgical knife; secondary outcomes included hemostatic procedures, time, curability, and adverse events.

Main Results:

• SCM-ESD achieved significantly higher completion rates without hemostatic forceps (83.1% vs. 13.8%, P < 0.0001).
• No significant differences were observed in procedure time, R0 resection rates, or adverse events between groups.
• The study included 65 patients per group.

Conclusions:

• SCM-ESD significantly enhances ESD completion rates for intramucosal EGNs by reducing the need for hemostatic forceps.
• SCM-ESD is a promising technique for streamlining ESD procedures, potentially lowering costs.
• This approach simplifies the surgical workflow by minimizing device exchanges.