Endoscopic submucosal dissection with traction assistance helped reduce procedure time and avoid adverse events in patients with large esophageal cancers, according to study results.
In Traction-assisted endoscopic submucosal dissection (TA-ESD), the endoscopist pulls the lesion in the oral direction which allows for tangential visualization of the dissection line, reducing the risk for technical difficulties.
“Compared with gastric or rectal ESD, esophageal ESD is more challenging because operating in the limited luminal space of the esophagus requires stronger technical skills and higher expertise,” Masao Yoshida, MD, of the division of endoscopy at Shizouka Cancer Center in Japan, and colleagues wrote. “Prolonged procedure duration is a key concern affecting the indication of esophageal cancers for ESD. Additionally, ESD has been associated with life-threatening adverse events including perforation, mediastinitis, pneumonitis, and pneumothorax.”
To determine if TA-ESD is superior to conventional ESD, researchers conducted a randomized, phase 3 trial known as CONNECT-E. They randomly assigned 232 patients with large esophageal cancer (tumor diameter > 20 mm) to undergo either conventional ESD or TA-ESD.
Yoshida and colleagues found that the TA-ESD had a shorter procedure duration compared with the conventional method (44.5 minutes vs. 60.5 minutes; P < .001). The procedure time remained shorter for TA-ESD compared with conventional regardless of tumor diameter (36 minutes vs. 52 minutes for 30 mm, P < .001; 61.5 minutes vs. 86.5 minutes for > 30 mm, P = .021).
While patients in the conventional group experienced perforation, none did in the TA-ESD group. There was also no difference between the groups in rate of horizontal margin involvement.
“CONNECT-E is the first phase 3 trial to evaluate and confirm the superiority of TA-ESD over conventional ESD in terms of procedure time,” Yoshida and colleagues wrote. “Because we also found no occurrence of perforation, we conclude that TA-ESD should be the preferred method for removing esophageal cancers [at least 20 mm in diameter].” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.