Insulated-tip Knife Tunneling and C-shaped Incision for Esophageal Endoscopic Submucosal Dissection: An Initial Western Experience

Background & Aims Esophageal endoscopic submucosal dissection (ESD) can be challenging, and technique innovation is needed to make it easier perform, especially in the West, where experience procedure volumes are less. The loose esophageal submucosa allows easy entry of entire ceramic tip an insulated-tip (IT) knife, allowing electrocautery blade dissect submucosa, while protects muscle layer. This called IT-knife tunneling has been described Japan. We evaluated safety feasibility ESD West. Methods A prospective, single-center observational study evaluating outcomes from April 2016-December 2019. Lesions with expected fibrosis were excluded. All ESDs performed by a single expert. Primary aim was determine technique. Results 42 patients underwent ESD. 35 Barrett's-related neoplasms, three squamous cell cancers, granular tumors, one cyst. Mean lesion size 3.1cm, time 69 min, resection speed 9.7 mm2/min. No perforations. One case each delayed bleeding significant intraprocedural bleeding. En-bloc, R0, curative rates 97.6%, 88.1%, 78.6%, respectively. 7/9 non-curative lesions high-risk poor surgical candidates. 36 under post-procedure surveillance. follow-up 12.1 months no local/metastatic recurrence. Conclusion allowed for safe feasible non-fibrotic at our Western center. Further use this West warranted.