Skip to main content
Top
Published in: Trials 1/2024

Open Access 01-12-2024 | Study protocol

Comparison of hemostatic ability between spray coagulation and forced coagulation modes in endoscopic submucosal dissection in patients with early gastric neoplasms: a study protocol for multicenter randomized controlled trial (Spray-G trial)

Authors: Kosuke Maehara, Mitsuru Esaki, Yorinobu Sumida, Daisuke Yamaguchi, Kei Nishioka, Hitoshi Homma, Taisuke Inada, Kazuo Shiotsuki, Shin-Ichiro Fukuda, Hirotada Akiho, Tadahiro Nomura, Yumi Mizuta, Satoshi Ishida, Shun Fujimoto, Shunichiro Kimura, Yuichiro Tanaka, Kaori Hata, Noriko Shiga, Tsutomu Iwasa, Yusuke Kimura, Norimoto Nakamura, Yusuke Suzuki, Yosuke Minoda, Yoshitaka Hata, Haruei Ogino, Koshiro Tagawa, Eikichi Ihara, Yoshihiro Ogawa

Published in: Trials | Issue 1/2024

Login to get access

Abstract

Background

Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric neoplasms (EGN). Controlling intraoperative bleeding is crucial for ensuring safe and reliable procedures. ESD using the spray coagulation mode (SCM-ESD) has been developed to control bleeding more effectively than ESD using the conventional forced coagulation mode (FCM-ESD). This study aims to compare the hemostatic efficacies of SCM-ESD and FCM-ESD.

Methods

This multicenter, prospective, parallel, randomized, open-label superiority trial will be conducted in five Japanese institutions. Patients with a preoperative diagnosis of intramucosal EGC will be randomized to undergo either SCM-ESD or FCM-ESD. The primary outcome measure is the completion of ESD with an electrosurgical knife alone, without the use of hemostatic forceps. Secondary outcomes include the number and duration of hemostasis using hemostatic forceps, procedure time, curability, and safety. A total of 130 patients will be enrolled in this study.

Discussion

This trial will provide evidence on the hemostatic efficacy of SCM-ESD compared with FCM-ESD in patients with intramucosal EGN, potentially improving the safety and reliability of ESD procedures.

Trial registration

The trial has been registered at the University Hospital Medical Information Network Clinical Trials Registration (UMIN-CTR) as UMIN000040518. The reception number is R000054009.
Appendix
Available only for authorised users
Literature
1.
go back to reference Ono H, Yao K, Fujishiro M, Oda I, Uedo N, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc. 2021;33(1):4–20.CrossRefPubMed Ono H, Yao K, Fujishiro M, Oda I, Uedo N, Nimura S, Yahagi N, Iishi H, Oka M, Ajioka Y, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer (second edition). Dig Endosc. 2021;33(1):4–20.CrossRefPubMed
2.
go back to reference Liu Q, Ding L, Qiu X, Meng F. Updated evaluation of endoscopic submucosal dissection versus surgery for early gastric cancer: a systematic review and meta-analysis. Int J Surg. 2020;73:28–41.CrossRefPubMed Liu Q, Ding L, Qiu X, Meng F. Updated evaluation of endoscopic submucosal dissection versus surgery for early gastric cancer: a systematic review and meta-analysis. Int J Surg. 2020;73:28–41.CrossRefPubMed
3.
go back to reference Lian J, Chen S, Zhang Y, Qiu F. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc. 2012;76(4):763–70.CrossRefPubMed Lian J, Chen S, Zhang Y, Qiu F. A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc. 2012;76(4):763–70.CrossRefPubMed
4.
go back to reference Tao M, Zhou X, Hu M, Pan J. Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis. BMJ Open. 2019;9(12):e025803.CrossRefPubMedPubMedCentral Tao M, Zhou X, Hu M, Pan J. Endoscopic submucosal dissection versus endoscopic mucosal resection for patients with early gastric cancer: a meta-analysis. BMJ Open. 2019;9(12):e025803.CrossRefPubMedPubMedCentral
5.
go back to reference Yamamoto S, Uedo N, Ishihara R, Kajimoto N, Ogiyama H, Fukushima Y, Yamamoto S, Takeuchi Y, Higashino K, Iishi H, et al. Endoscopic submucosal dissection for early gastric cancer performed by supervised residents: assessment of feasibility and learning curve. Endoscopy. 2009;41(11):923–8.CrossRefPubMed Yamamoto S, Uedo N, Ishihara R, Kajimoto N, Ogiyama H, Fukushima Y, Yamamoto S, Takeuchi Y, Higashino K, Iishi H, et al. Endoscopic submucosal dissection for early gastric cancer performed by supervised residents: assessment of feasibility and learning curve. Endoscopy. 2009;41(11):923–8.CrossRefPubMed
6.
go back to reference Tanaka S, Toyonaga T, Morita Y, Ishida T, Hoshi N, Grimes KL, Ohara Y, Yoshizaki T, Kawara F, Umegaki E, et al. Efficacy of a new hemostatic forceps during gastric endoscopic submucosal dissection: a prospective randomized controlled trial. J Gastroenterol Hepatol. 2017;32(4):846–51.CrossRefPubMed Tanaka S, Toyonaga T, Morita Y, Ishida T, Hoshi N, Grimes KL, Ohara Y, Yoshizaki T, Kawara F, Umegaki E, et al. Efficacy of a new hemostatic forceps during gastric endoscopic submucosal dissection: a prospective randomized controlled trial. J Gastroenterol Hepatol. 2017;32(4):846–51.CrossRefPubMed
7.
go back to reference Morita Y. Electrocautery for ESD: settings of the electrical surgical unit VIO300D. Gastrointest Endosc Clin N Am. 2014;24(2):183–9.CrossRefPubMed Morita Y. Electrocautery for ESD: settings of the electrical surgical unit VIO300D. Gastrointest Endosc Clin N Am. 2014;24(2):183–9.CrossRefPubMed
8.
go back to reference Toyonaga T, Man IM, Fujita T, Nishino E, Ono W, Morita Y, Sanuki T, Masuda A, Yoshida M, Kutsumi H, et al. The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case-control study. Aliment Pharmacol Ther. 2010;32(7):908–15.CrossRefPubMed Toyonaga T, Man IM, Fujita T, Nishino E, Ono W, Morita Y, Sanuki T, Masuda A, Yoshida M, Kutsumi H, et al. The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case-control study. Aliment Pharmacol Ther. 2010;32(7):908–15.CrossRefPubMed
9.
go back to reference Esaki M, Suzuki S, Hayashi Y, Yokoyama A, Abe S, Hosokawa T, Ogino H, Akiho H, Ihara E, Ogawa Y. Splash M-knife versus Flush Knife BT in the technical outcomes of endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis. BMC Gastroenterol. 2018;18(1):35.CrossRefPubMedPubMedCentral Esaki M, Suzuki S, Hayashi Y, Yokoyama A, Abe S, Hosokawa T, Ogino H, Akiho H, Ihara E, Ogawa Y. Splash M-knife versus Flush Knife BT in the technical outcomes of endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis. BMC Gastroenterol. 2018;18(1):35.CrossRefPubMedPubMedCentral
10.
go back to reference Kv A, Katukuri GR, Lakhtakia S, Ramchandani M, Reddy DN. Hemostasis during endoscopic necrosectomy: spray coagulation can be a savior! Am J Gastroenterol. 2022;117(3):375–6.CrossRefPubMed Kv A, Katukuri GR, Lakhtakia S, Ramchandani M, Reddy DN. Hemostasis during endoscopic necrosectomy: spray coagulation can be a savior! Am J Gastroenterol. 2022;117(3):375–6.CrossRefPubMed
11.
go back to reference Hamaguchi K, Nomura T, Ito K, Kobayashi M. Snare-tip spray spark coagulation technique for bleeding secondary to gastric antral vascular ectasia. Endoscopy. 2022;54(10):E562–3.CrossRefPubMed Hamaguchi K, Nomura T, Ito K, Kobayashi M. Snare-tip spray spark coagulation technique for bleeding secondary to gastric antral vascular ectasia. Endoscopy. 2022;54(10):E562–3.CrossRefPubMed
12.
go back to reference Yen HH. Gastrointestinal: Spray coagulation with snare tip as a rescue therapy to argon plasma coagulation for bleeding jejunal angioectasia. J Gastroenterol Hepatol. 2017;32(12):1909.CrossRefPubMed Yen HH. Gastrointestinal: Spray coagulation with snare tip as a rescue therapy to argon plasma coagulation for bleeding jejunal angioectasia. J Gastroenterol Hepatol. 2017;32(12):1909.CrossRefPubMed
13.
go back to reference Iwai S, Kobayashi S, Torai S, Kobayashi E. Development and application of a spray tip that enables electrocoagulation of a variety of tissues. Heliyon. 2023;9(8):e17771.CrossRefPubMedPubMedCentral Iwai S, Kobayashi S, Torai S, Kobayashi E. Development and application of a spray tip that enables electrocoagulation of a variety of tissues. Heliyon. 2023;9(8):e17771.CrossRefPubMedPubMedCentral
14.
go back to reference Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hrobjartsson A, Schulz KF, Parulekar WR, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586.CrossRefPubMedPubMedCentral Chan AW, Tetzlaff JM, Gotzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hrobjartsson A, Schulz KF, Parulekar WR, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586.CrossRefPubMedPubMedCentral
15.
go back to reference Yoshii S, Yamano HO, Nakase H. Novel injectable needle-type knife, ProKnife for colorectal endoscopic submucosal dissection. Dig Endosc. 2021;33(6):e137–9.PubMed Yoshii S, Yamano HO, Nakase H. Novel injectable needle-type knife, ProKnife for colorectal endoscopic submucosal dissection. Dig Endosc. 2021;33(6):e137–9.PubMed
16.
go back to reference Esaki M, Ihara E, Esaki M, Nishioka K, Kimura Y, Hata Y, Tsuru H, Wada M, Minoda Y, Bai X, et al. Comparisons of outcomes between ProKnife injection endoscopic submucosal dissection and conventional endoscopic submucosal dissection for large gastric lesions in ex vivo porcine model study: a randomized controlled trial. DEN Open. 2022;2(1):e91.CrossRefPubMedPubMedCentral Esaki M, Ihara E, Esaki M, Nishioka K, Kimura Y, Hata Y, Tsuru H, Wada M, Minoda Y, Bai X, et al. Comparisons of outcomes between ProKnife injection endoscopic submucosal dissection and conventional endoscopic submucosal dissection for large gastric lesions in ex vivo porcine model study: a randomized controlled trial. DEN Open. 2022;2(1):e91.CrossRefPubMedPubMedCentral
17.
go back to reference Japanese Gastric Cancer A. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.CrossRef Japanese Gastric Cancer A. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.CrossRef
18.
go back to reference Fujishiro M, Iguchi M, Kakushima N, Kato M, Sakata Y, Hoteya S, Kataoka M, Shimaoka S, Yahagi N, Fujimoto K. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding. Dig Endosc. 2016;28(4):363–78.CrossRefPubMed Fujishiro M, Iguchi M, Kakushima N, Kato M, Sakata Y, Hoteya S, Kataoka M, Shimaoka S, Yahagi N, Fujimoto K. Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding. Dig Endosc. 2016;28(4):363–78.CrossRefPubMed
19.
go back to reference Suzuki H, Takizawa K, Hirasawa T, Takeuchi Y, Ishido K, Hoteya S, Yano T, Tanaka S, Endo M, Nakagawa M, et al. Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: ‘real-world evidence’ in Japan. Dig Endosc. 2019;31(1):30–9.CrossRefPubMed Suzuki H, Takizawa K, Hirasawa T, Takeuchi Y, Ishido K, Hoteya S, Yano T, Tanaka S, Endo M, Nakagawa M, et al. Short-term outcomes of multicenter prospective cohort study of gastric endoscopic resection: ‘real-world evidence’ in Japan. Dig Endosc. 2019;31(1):30–9.CrossRefPubMed
Metadata
Title
Comparison of hemostatic ability between spray coagulation and forced coagulation modes in endoscopic submucosal dissection in patients with early gastric neoplasms: a study protocol for multicenter randomized controlled trial (Spray-G trial)
Authors
Kosuke Maehara
Mitsuru Esaki
Yorinobu Sumida
Daisuke Yamaguchi
Kei Nishioka
Hitoshi Homma
Taisuke Inada
Kazuo Shiotsuki
Shin-Ichiro Fukuda
Hirotada Akiho
Tadahiro Nomura
Yumi Mizuta
Satoshi Ishida
Shun Fujimoto
Shunichiro Kimura
Yuichiro Tanaka
Kaori Hata
Noriko Shiga
Tsutomu Iwasa
Yusuke Kimura
Norimoto Nakamura
Yusuke Suzuki
Yosuke Minoda
Yoshitaka Hata
Haruei Ogino
Koshiro Tagawa
Eikichi Ihara
Yoshihiro Ogawa
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Trials / Issue 1/2024
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-023-07852-6

Other articles of this Issue 1/2024

Trials 1/2024 Go to the issue