Usefulness of the combined orthodontic rubber band and clip method for gastric endoscopic submucosal dissection.

BACKGROUND AND AIMS: Effective traction is an important prerequisite for successful endoscopic submucosal dissection (ESD). The combined orthodontic rubber band (ORB) and clip method was effective in colorectal cancer ESD. To date, the method was not reported in gastric ESD. This study aimed to investigate its efficacy and safety for gastric neoplasms ESD. METHODS: We retrospectively analyzed data of 118 patients with gastric neoplasms treated by ESD from November 2020 to April 2022, 43 by ORB-ESD and 75 by the conventional ESD. The primary outcome measure was the ESD procedure time. Clinical data on efficacy and safety were also collected and analyzed. Propensity score matching (PSM) matched the patients in both groups. RESULTS: PSM successfully matched 31 pairs of patients. The ORB-ESD operation time was shorter (median [interquartile range], 35 [30-48] vs. 49 [40-70] min, P < 0.001) and dissection speed was higher (median [interquartile range], 22.6 [14.4-29.3] vs. 13.5 [9.6-17.9] mm2/min, P < 0.001) than in the conventional ESD. The groups were similar in muscular injury rate, frequency and time of use of thermal hemostatic forceps, postoperative adverse events, en bloc resection, and R0 resection rate (P > 0.05). CONCLUSIONS: Compared to the conventional ESD, ORB-ESD significantly reduced the procedure time and increased the dissection speed, proving beneficial to gastric ESD.

Orthodontic rubber band traction to facilitate endoscopic resection of gastric submucosal tumor.

BACKGROUND AND STUDY AIMS: Endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFTR) are common endoscopic minimally invasive methods for treatment of gastric submucosal tumors (SMTs). However, it is sometimes difficult to expose the tumor optimally. This study aimed to explore the safety and effectiveness of tumor traction using orthodontic rubber band (ORB) combined with clips to assist ESE and EFTR of gastric SMTs. PATIENTS AND METHODS: The data of patients with gastric SMTs who underwent ESE or EFR at the Endoscopy Center of the 900th Hospital of PLA from January 2021 to May 2022 were retrospectively analyzed. Baseline characteristics and clinical outcomes, including operation time and postoperative adverse events, were compared between patients receiving ORB-ESE/EFTR and conventional ESE/EFTR. RESULTS: A total of 52 patients were enrolled: 16 patients who underwent ORB-ESE /EFTR and 36 patients who underwent conventional ESE/EFTR. Median procedure time was significantly shorter in the ORB-ESE/EFTR group than in the conventional ESE/EFTR group (32 [IQR, 23.8, 38.0] minutes vs. 39.0 [IQR, 34.6-67.3] minutes, P = 0.002). Baseline characteristics, en bloc resection rate, incidence of postoperative adverse events, and postoperative pathology results were comparable between the two groups (P > 0.05). CONCLUSION: Use of ORB with clips-assisted traction during ESE/EFTR of gastric SMT can shorten the surgical time. Further large prospective studies are needed to confirm the findings of this study.