UEG Week 2013 Poster Presentations

INTRODUCTION: In Western countries, ESD was not commonly performed because the submocosal dissection is technically challenging. We reported that the injection of mesna solution (sodium-2-mercaptoethanesulfonate) made submucosal connective tissues chemically softened and facilitated mechanical dissection of the submucosal layer in the stomach [1]. Our previous study suggested that mechanical dissection with mesna might make an ESD for gastric cancer safer and easier. There has been no study to evaluate the feasibility of mechanical dissection with mesna for superficial oesophageal squamous neoplasms (SOSNs). AIMS&METHODS: The aim of this study was to evaluate the feasibility and safety of chemically assisted ESD using mesna in 20 consecutive patients with SOSNs. Submucosal fluid cushion was made by 0.4% sodium hyaluronate and then the lesion was circumferentially isolated from surrounding normal mucosa as a conventional ESD method with needle knife (Dual knife, Olympus medical systems). After that, 4 to 8 mL of 10% mesna solution was injected into the submucosal layer and mechanical submucosal dissection was performed by cleaving the submucosal layer with the tip of a cap-fitted endoscope. The number of electrosurgical incision as well as coagulation for hemostasis by stepping the foot switch of high-frequency wave apparatus (VIO 300, ERBE) and the procedural time were recorded by dedicated software (VIO Doku, ERBE) in real time. We also performed conventional ESD without mesna for each consecutive10 SOSNs as control during before and after mesna ESD. Operators and lesion size matched paired t test was analyzed by comparing each result of mesna and conventional ESD groups. RESULTS: The mean size of resected sample was 31.1 8.6 mm, with an en bloc resection rate of 100%. The number of electrosurgical incision during submucosal dissection procedure in mesna group was significantly smaller than that in conventional group (mean; 89.8 82.3 vs. 232.4 150.9 times, p50.01). The procedural time of submucosal dissection in mesna group tended to be shorter than that in conventional group (mean; 10.5 vs. 17.3 minutes, p1⁄40.056) while there was no significant difference. There was also no significant difference between mesna and conventional groups in the number of coagulation for hemostasis (mean; 7.1 vs. 3.8 times, p1⁄40.19). There was no perforation and no uncontrollable hemorrhage. Ulcerations healed normally within 2 months. CONCLUSION: The mechanical submucosal dissection with mesna for SOSNs deem safe and may facilitate procedure of conventional ESD. REFERENCES: 1. Sumiyama K et al. Endoscopy 2010; 42: 627–632 Disclosure of Interest: None Declared