The “tunnel + clip” strategy standardised and facilitates oesophageal ESD procedures: a prospective, consecutive bi-centric study



ESD is the treatment of choice for superficial neoplasms of the oesophagus; ESD is oncologically efficient and associated with less morbidity than the surgical alternative. ESD requires a high level of skill, being both technically challenging and time consuming. Therefore, ESD is often reserved for experts. A combination of a tunnel technique with clip-line traction may enable optimisation of oesophageal ESD.

Patients and methods

From January 2015 to December 2016, we performed a prospective two-centre case study of consecutive “tunnel + clip” oesophageal ESD. Four young operators (each of whom had performed fewer than 50 ESDs and fewer than five oesophageal ESDs) treated patients requiring ESD using the tunnel + clip method. This involves generation of a classic tunnel beneath the lesion, with constant traction being applied by a clip with a line placed at the oral side of the tunnel.


Sixty-two lesions (25 SCCs and 34 ADK/HGDs complicating Barrett’s oesophagus) were consecutively resected. The en bloc, R0, and curative resection rates were 100% (62/62), 88.7% (55/62), and 74.2% (46/62), respectively. No perforation was noted. The mean ESD velocity was 24.5 mm2/min for lesions of mean length 59.6 mm. The tunnel + clip approach greatly aided the procedure. No pathological damage caused by clipping was evident.


Use of the tunnel + clip strategy to treat oesophageal ESD is effective and safe, even when performed by physicians with little prior experience. It is thus possible to standardise ESD of superficial oesophageal neoplasms and increase the velocity of dissection. Our procedure will encourage the use of oesophageal ESD in Western countries.

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Correspondence to Jérémie Jacques.

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Dr Jérémie Jacques: Meetings invitation: Abbvie, Hospira, Norgine ; Lectures for Abbvie, Hospira. Dr Romain Legros :Meetings invitation: Abbvie, Boston scientific; Lectures for Hospira. Dr Jérôme Rivory: Meetings invitation: MSD, Abbvie, Norgine, Boston scientific; Lecture: Norgine. Dr Aurélie Charissoux has nothing to disclose linked to this study. Pr Denis Sautereau Meetings invitation: MSD, Abbvie, Lecture: Abbvie. Pr Thierry Ponchon: Olympus: advisory board member, lecture and clinical research, Boston Scientific: advisory board member, lecture and clinical research, Cook Medical: advisory board member and clinical research, Fujifilm: lecture and clinical research, Medtronics: advisory board member, lecture and clinical research, Ipsen pharma: advisory board member, lecture and clinical research, Ferring: lecture, Nestis: shareholder. Dr Mathieu Pioche : Advisory board Boston scientific, meetings invitation Boston scientific for UEGW and JFHOD, ESD hands on training as a teacher for Olympus, lecture for olympus.

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"Tunnel + Clip" stratedy for ESD of a squamous cell carcinoma of the esophagus—Supplementary video 1 (MP4 478785 KB)

"Tunnel + Clip" stratedy for ESD of a squamous cell carcinoma of the esophagus—Supplementary video 1 (MP4 478785 KB)

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Jacques, J., Legros, R., Rivory, J. et al. The “tunnel + clip” strategy standardised and facilitates oesophageal ESD procedures: a prospective, consecutive bi-centric study. Surg Endosc 31, 4838–4847 (2017).

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  • Oesophageal ESD
  • Countertraction
  • Tunnel ESD
  • Clip with line