Comparison Of Effectiveness And Safety Of Endoscopic Submucosal Dissection With Dual Knife And IT Knife In Patients Of Superficial Esophageal Cancer And Precancerous Lesions

Objective:By comparing the differences of operation time,removal speed,cure removal rate and incidence of complications such as bleeding,perforation and stenosis,Exploring the effectiveness and safety of endoscopic submucous separation(ESD)between dual knife and IT knife in patients of superficial esophageal cancer and precancerous lesions respectively.Methods:The patients with superficial esophageal cancer and precancerous lesions who undergone endoscopic submucosal dissection(ESD)in the Department of gastroenterology,changzhou jintan district people’s hospital from September 2017 to February 2020 were included in this study.We divided them into Dual knife group and Dual+IT knife group,analyze the differences of complete and curative excision,surgery time,rate of removal,length of hospitalization,hospital cost and complications in two groups with statistical methods.Results:A total of 32 cases in the Dual knife group,16 males and 16 females,with an average age of(63.22± 11.82)years;a total of 30 cases in the Dual+IT knife group,18 males and 12 females,with an average age of(64.23±7.39)years.There is no significant difference in gender and age between the two groups.62 patients were successfully operated.The average area of lesions in Dual knife group and Dual+IT knife group was(9.37±8.02cm2,7.16±2.58cm2)P=0.676,no statistical difference.The average operation time(60.88±10.58min/66.40±8.14min)P=0.012,the average resection speed(0.14±0.10cm2/min and 0.09±0.03cm2/min)P=0.043,the operation time of the Dual knife group is shorter,the resection speed Faster,all have statistical significance.The incidence of complications in the two groups was 4(12.5%)and 12(40%).There were 2 cases(6.25%)and 9 cases(30%)with more intraoperative bleeding,which were effectively controlled by electrocoagulation hemostatic forceps.The surgical field of the v.Dual knife group was clearer,and the preventive hemostatic and immediate hemostatic effects during operation were significantly better than the Dual+IT knife group(P=0.02).There were 2 cases(6.25%)and 3 cases(10%)with esophageal stenosis after operation,respectively,P=0.667 had no significant statistical difference.The patients alleviated their symptoms after endoscopic dilatation of the saline probe.No perforation occurred in both groups,and there was no delayed bleeding after operation.The hospitalization costs were 1,662.134±1153.75 yuan and 17,643.14±795.78 yuan respectively.The cost of hospitalization in the Dual Knife group was lower,P=0.02 was statistically significant.Conclusion:Compared with the Dual+IT knife group,the Dual knife group has no significant difference in the curative resection rate of ESD treatment of superficial esophageal cancer and precancerous lesions,but the Dual knife group has a short operation time,fast resection speed,and high effectiveness.The intraoperative preventive hemostasis and immediate hemostasis effect of the Dual knife group is significantly better than the Dual+IT knife group,which can effectively reduce the risk of intraoperative bleeding and has higher safety.The cost of hospitalization of the Dual knife group is lower,and the Dual knife group has advantages in consideration of cost efficiency.