Dual-operator thin endoscope combination surgery for endoscopic submucosal dissection of gastrointestinal epithelial...

Thin endoscope combination surgery (TECS) is a dual-operator technique using two identical thin therapeutic endoscopes to enable dynamic traction and task sharing during advanced endoscopic treatment. This study aimed to evaluate the feasibility, safety, and procedural characteristics of TECS in clinical practice and characterize the learning curve for a fixed operator-assistant team adopting this approach.

We retrospectively analyzed the data of consecutive patients who underwent TECS for gastrointestinal epithelial tumors between January and December 2024. The primary outcome was technical success without conversion. Secondary outcomes included en bloc and R0 resection, treatment time, resection speed, and adverse events (AEs; captured during hospitalization and within 30 days).

Forty-five patients were enrolled; one was excluded for inadequate sedation, leaving 44 eligible. TECS was completed in 43 cases (26 gastric, 17 colorectal); 41 epithelial neoplasms were included in efficacy analyses. En bloc and R0 resection were achieved in all neoplastic cases. No intra- or delayed AEs occurred in the 43 completed procedures (0/43; two-sided 95% confidence interval [CI], 0.0-8.2). In a learning-curve subset performed by a fixed operator-assistant team (n = 32), median treatment time decreased from 59 to 27 min (p = 0.003), and median resection speed increased from 20.9 to 48.4 mm²/min (p = 0.002). Technical success rate was 97.7% (43/44; 95% CI 88.0-99.9).

TECS was feasible and safe in this pilot series, enabling continuously adjustable, bidirectional traction and task sharing. Prospective multicenter studies are warranted to validate indications, safety, reproducibility, and cost-effectiveness.