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Original Article A new hemostatic device for gastric endoscopic submucosal dissection: a prospective randomized controlled trial comparing Coajet and Hemograsper in Korea
Sang Un Kim1orcid, Seong Woo Jeon1,2orcid

DOI: https://doi.org/10.5946/ce.2024.295
Published online: June 4, 2025

1Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea

2Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence: Seong Woo Jeon Department of Internal Medicine, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea E-mail: swjeon@knu.ac.kr
• Received: November 2, 2024   • Revised: December 24, 2024   • Accepted: December 25, 2024

© 2025 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background/Aims
    Gastric endoscopic submucosal dissection (ESD) is often accompanied by bleeding. Coajet, a new device containing an injection needle, has been found to be useful in achieving hemostasis through monopolar contact. This study aimed to evaluate the efficacy and safety of this new hemostatic device by comparing it to hemostatic forceps (Hemograsper).
  • Methods
    This prospective, randomized, single-center study enrolled consecutive patients scheduled to undergo gastric ESD from February 2022 to January 2023. The Hemograsper group (HG) underwent hemostasis using the conventional method, whereas the Coajet group (CG) used this new tool for lesion marking, submucosal injection in the initial stage of ESD, and then for hemostasis.
  • Results
    A total 56 patients were enrolled in this study (HG, 28; CG, 28). No significant differences in age, sex, diagnosis, location, endoscopic size, or morphology were observed between the two groups. No significant difference in total operative time (HG, 16.0±6.9 minutes vs. CG, 12.4±6.7 minutes; p=0.05) and hemostatic time (HG, 186.6±134.5 seconds vs. CG, 130.4±81.5 seconds; p=0.06) were observed between the two groups. No differences in other procedure-related variables, such as complete en-bloc resection rate, length of admission, grade of immediate bleeding, and delayed bleeding within 30 days (HG, n=1 vs. CG, n=1), were noted.
  • Conclusions
    The new hemostatic device, Coajet, showed comparable efficacy to that of conventional hemostatic forceps for bleeding control and the prevention of delayed bleeding in gastric ESD.
  • Keywords: Endoscopy; Equipment and supplies; Hemostasis
Endoscopic resection methods can be largely divided into conventional endoscopic mucosal resection and endoscopic submucosal dissection (ESD).1,2 Compared with conventional endoscopic mucosal resection, ESD has several advantages, including its ability to be performed regardless of lesion size or location.3 The primary purpose of ESD is to prevent complications, such as perforation or bleeding, during en-bloc resection. ESD also enables complete resection, regardless of lesion size owing to its accurate evaluation of the lesion margin, which allows for the resection of large lesions and sufficient pathological evaluation of the risk for lymph node and blood vessel invasion from the acquired tissue.3-5 However, complications such as bleeding and perforation can often occur during ESD, which requires advanced techniques along with safe and more effective surgical instruments.
The most frequently encountered complication during ESD procedures is bleeding, which is managed by incorporating hemostasis to maintain hemodynamic stability during the procedure and to prevent delayed bleeding after the procedure. Small bleeding during the procedure can be controlled using an endoscopic knife; however, continuous bleeding from large blood vessels is generally managed using forceps for hemostasis.6-8 In Japan, a product called Coagrasper (FD-410LR; Olympus Medical Systems) has been widely used for ESD. This tool is useful for most procedures requiring hemostasis but is difficult to use in large pulsating vessels or deep vessels in the submucosal layer.8-11 In addition, ESD procedures in the stomach are often accompanied by bleeding, which often prolongs the operative time.
To compensate for these shortcomings, a device called Hemograsper (Finemedix Co., Ltd.), which had the same hemostatic capacity as Coagrasper but improved rotationality and operability, was developed. In addition, Coajet (Finemedix Co., Ltd.) was created as a useful tool for hemostasis through contact during the procedure. This device contains an injection needle that can be used for marking around the lesion, submucosal fluid injection, and hemostasis, thereby reducing operative time. Therefore, the current clinical study aimed to evaluate the safety and effectiveness of these new hemostatic devices.
This study employed a prospective, randomized controlled design. Patients scheduled to undergo gastric ESD were consecutively enrolled from February 2022 to January 2023. This study was conducted at a single endoscopic center in Korea, the Kyungpook National University Chilgok Hospital. To reduce biases between endoscopists, all ESD procedures were performed by a single endoscopist (S.W.J.), who had performed over 5,000 cases of gastric ESD.
Participants
Patients with dysplasia of any size or early gastric cancer (EGC) who satisfied all of the following inclusion criteria were enrolled in the study: (1) differentiated intramucosal adenocarcinoma without ulceration, regardless of size, or ulcerated intramucosal adenocarcinoma <3 cm in size, and (2) no evidence of distant or lymph node metastasis. The lesions were evaluated based on endoscopy, endoscopic ultrasonography, and computed tomography findings. Patients were excluded if they met any of the following conditions: (1) a previous history of ESD; (2) uncontrolled severe cardiovascular, liver, lung, nervous system, or psychiatric disorders/cancer or AIDS/other gastrointestinal or endocrine disorders; (3) use of medications such as aspirin or clopidogrel, which affect bleeding; and (4) history of gastrectomy for any reason. Written informed consent was obtained from all patients before enrollment. The patients were randomly assigned to either the Hemograsper group (HG) or Coajet group (CG) based on a computer-generated randomization sheet (Fig. 1).
Coajet versus Hemograsper
The Hemograsper is a pair of hemostatic forceps with an opening width of 5 mm, a rotational function, and an irrigation port. The Coajet is a hybrid hemostatic device that combines an injector and a coagulator to enable lesion marking, submucosal injection, mucosal resection, and coagulation. This device reduces operative time by minimizing the time spent on device replacement during the procedure (Fig. 2).
The HG underwent hemostatic treatment by cauterizing the exposed blood vessels with electricity after grasping them, whereas the CG underwent hemostasis by contacting the distal part of the exposed blood vessels with electricity, either during or after completing the procedure. Using preventive hemostasis during and after the procedure would not promote differences in outcomes; however, Coajet has the advantage of allowing submucosal injection without exchanging instruments during the procedure.
ESD procedure
ESD was performed in the following order: (1) the area around the lesion was marked with cautery using a knife in the HG (O type; Finemedix Co., Ltd.) and the Coajet in the CG; (2) physiological saline mixed with epinephrine was injected into the submucosa around the lesion using a conventional injection catheter in the HG and the Coajet in the CG; (3) after incising the mucosa, the area around the lesion was cut circumferentially with an insulated-tip knife (O type); (4) saline was injected into the submucosal layer below the lesion, and then the lesion was dissected using a knife; (5) bleeding during the procedure was managed using a knife for trivial bleeding and the Hemograsper or Coajet for bleeding greater than minor. No traction was used, and all procedures were performed according to standard ESD procedures. Our procedure was performed using an insulated-tip knife (O type knife) through a single-channel endoscope (GIF-H190; Olympus Medical Systems) with a water jet function. A VIO 300D (ERBE Elektromedizin GmbH) was used as the power source for electrical cutting and coagulation. The total procedure time was defined as the duration from the insertion of the first instrument (knife or Coajet) to the completion of prophylactic hemostasis.
Complications
Bleeding can be subdivided into immediate and delayed bleeding after the procedure, depending on the timing of bleeding. The management of immediate bleeding plays a critical role in successfully completing ESD. Immediate bleeding, defined as bleeding during the procedure, can be classified as follows: grade 0 (no visible bleeding during the procedure), grade 1 (trivial bleeding that stops spontaneously or is easily controlled by a single session of hemocoagulation with a knife or hemostatic devices), grade 2 (minor bleeding that can be controlled by multiple sessions of hemocoagulation or easily controlled by hemoclips), and grade 3 (major bleeding requiring multiple hemoclips and hemocoagulation).12 Delayed bleeding is defined as clinical signs of bleeding, such as hematemesis or melena, unstable vital signs, a decrease in hemoglobin exceeding 2 g/dL, or bleeding requiring transfusion or endoscopic treatment.
Hemostasis
Bleeding that occurred during ESD was initially managed using a knife. If bleeding occurred during submucosal dissection, coagulation was first attempted with a knife. If hemostasis failed after 2 or 3 attempts with the knife (swift coagulation mode effect 3, 50 W), hemostasis was performed using Coajet or Hemograsper (soft coagulation mode effect 7, 80 W). Prophylactic hemostasis after completion of submucosal dissection was similarly performed using Coajet or Hemograsper. After two or three failed attempts with the knife, a Hemograsper or Coajet was used. The procedure was recorded and independently evaluated after the procedure using photographs and videos (Supplementary Video 1). Hemostasis time was defined as the sum of the time spent on hemostasis and was measured as the duration from the moment the hemostatic forceps or Coajet appeared through the endoscopic channel until hemostasis was confirmed.
End points
The primary endpoint was the time required for hemostasis in all instances of bleeding. The secondary endpoints were total procedure time, adverse event rate, complete resection rate, en-bloc resection rate, lymphovascular invasion, and requirement for additional surgery. Procedure and hemostasis time were measured directly by the practitioner through endoscopic photograph reviews. The complete resection rate was defined by the pathology department as en-bloc resection with tumor-free lateral and vertical margins. In addition, tumor location, lesion size and shape, histological diagnosis, and presence of ulcers were evaluated to compare differences between the two groups. The analysis was performed by an experienced pathologist who was blinded to the two groups to minimize potential bias.
Statistical analysis
The sample size was calculated based on a preliminary investigation of the efficacy of hemostatic forceps in gastric ESD.9 We estimated the expected hemostasis time for Hemograsper to be 63 s, and the expected hemostasis time for Coajet to be 46 seconds, a 30% reduction. Assuming a 5% significance level and 80% statistical power, we performed a power analysis, which determined that 28 patients would be needed in each group, resulting in a final sample size of 56 patients. Statistical analyses were performed using the IBM SPSS ver. 29.0 (IBM Corp.). Data were expressed as mean±standard error of the mean. To assess differences between the CG and HG, Student's t-test for continuous variables and the chi-square test for categorical variables were used. A value of p<0.05 was considered statistically significant.
Ethical statements
This study was approved by the Institutional Review Board of Kyungpook National University Chilgok Hospital (KNUCH 2021-10-017-001) and was registered in CRIS (KCT0007005).
Baseline characteristics
Patient baseline characteristics, pathological results at diagnosis, lesion location, lesion size, presence of ulcers, and lesion morphology are described in Table 1. After comparing the CG (n=28) and HG (n=28) groups, no significant differences in mean age, sex distribution, prevalence of comorbidities, mean height, and mean weight were observed. Additionally, no significant differences in pre-resection diagnosis, lesion characteristics, and endoscopic findings were observed between the two groups. This encompassed the distribution of cases concerning EGC, low-grade dysplasia, and high-grade dysplasia, differentiation analysis of EGC cases, lesion locations, endoscopic sizes, presence of ulcers, types of lesions (IIa, IIb, IIc, and IIa+IIc), and Helicobacter pylori infection. Overall, no significant divergence in the baseline characteristics examined in this study was observed between the CG and HG.
Procedure results
The total operative time did not show a significant difference between the CG (12.4±6.7 minutes) and the HG (16.0±6.9 minutes; p=0.05). The total hemostatic time was 130.4±81.5 seconds and 186.6±134.5 seconds in the CG and HG, respectively. The hemostasis time was shorter in the CG than that in the HG, although the difference was not statistically significant (p=0.06). Bleeding complications were assessed in both immediate and delayed settings. No significant differences were observed in the immediate and delayed bleeding rates between the two groups (p=0.66). Additionally, the distribution of final histological findings, specimen size, lesion size, pathological complete resection outcomes, submucosal invasion depth, and lymphovascular invasion rates did not differ significantly between the groups, indicating overall similarities in these aspects of the procedure (Table 2).
This prospective randomized controlled trial compared the effectiveness and safety of a new hemostatic device, Coajet, with those of conventional hemostatic forceps (Hemograsper) among 56 patients (28 in each group) undergoing gastric ESD.
No significant differences in the total operative time and hemostatic time were observed between the two groups, although a slight decrease was observed in the CG. No significant differences in other procedure-related variables, such as complete en-bloc resection rate, length of admission, grade of immediate bleeding, and delayed bleeding within 30 days, were observed. Our sub-analysis revealed no significant differences in specimen and lesion size, pathologically complete resection results, and depth of submucosal invasion between the two groups. This indicated the effectiveness of both devices in achieving the basic goals of ESD.
The current study found a marginal decrease in hemostasis time in the CG. To enhance the safety and effectiveness of these procedures, research has focused on hemostasis during and after ESD.13,14 Bleeding during ESD can delay the procedure time and interfere with the visibility of the procedure area, potentially resulting in incomplete resection and promoting adverse effects such as perforation. Therefore, various devices for hemostasis are being researched and developed. Instruments for hemostasis include hemostatic probes, hemostatic forceps, hemostatic sprays, and sealants.11,15,16 Common options for managing bleeding during a procedure include coagulation probes and hemostatic forceps, each with their own advantages and specific uses.6,8,9,16 Coagulation probes can rapidly and accurately target and treat small blood vessels. Hemostatic forceps can control bleeding by grasping the bleeding point and applying immediate pressure. The choice between a coagulation probe and hemostatic forceps may depend on the nature and severity of the bleeding. They can also be used in various ways, depending on the endoscopist’s preference and skill level.7 Currently, several hemostatic forceps are under development, but the same is not true for coagulation probes, indicating that there are fewer options for coagulation probes.9 Therefore, we have developed a new hemostatic device, called Coajet, which is useful for rapid hemostasis through contact during the procedure and can be used at various stages throughout the procedure, including during submucosal injection, for convenience. Interestingly, the current study found no difference in the hemostatic efficacy between the Coajet and hemostatic forceps. This finding was likely attributed to the lack of severe bleeding during the procedure, as most bleeding was controlled with a knife, which did not differ between the two groups. If bleeding during submucosal dissection is frequent, Coajet may have an advantage over Hemograsper. The combined injection and coagulation capabilities of Coajet may reduce instrument change times. The decrease in total procedure time can be explained by the reduction in instrument change time and the simplification of the procedure steps. Several instruments, such as the Dual knife (Olympus Medical Systems), Hybrid knife (ERBE Elektromedizin GmbH), Flush knife (Fujifilm), and Dual knife J (Olympus Medical Systems),6-8,11,17,18 have been developed to increase convenience during the procedure. The reduction in total procedure time can be attributed to the decrease in the number of instrument exchanges by implementing the injection and coagulation functions together. Coajet can be used for injection, marking, and precut, and has the advantage of reducing instrument replacement time during procedures while allowing immediate hemostasis in the event of bleeding. It is believed that Coajet may have a greater hemostasis advantage in situations involving repetitive bleeding and repeated injections, especially when using an endoscope without an integrated water jet. When bleeding occurs, it is important to identify the exact bleeding site for hemostasis. If a water jet function were available, we could wash away blood, find the exact bleeding site, and use a device such as a Hemograsper to stop the bleeding. However, if we do not have a water jet function, we can use the accessory channel to wash away the blood and then insert a device to stop the bleeding. In this case, the bleeding area may be covered again during the time a device is inserted. Coajet has both injection and water infusion functions; therefore, if bleeding continues, it will help locate the exact bleeding site and quickly achieve hemostasis. However, a clot may block the injection channel or restrict needle movement during hemostasis with Coajet. To prevent this or unblock a blocked channel, regular flushing of the injection channel with saline can be used during the procedure.
This study has several limitations. First, the sample size was relatively small. When we initially designed the study, we did not consider a non-inferiority design. Therefore, a larger sample size is needed to draw more definitive conclusions. Additionally, this study was performed at a single center, which may limit the generalizability of the results. This limitation can be addressed by conducting studies with more participants or involving multiple centers. The second limitation is endoscopist bias. Despite our efforts to minimize bias by having a single experienced endoscopist perform all procedures, individual surgical skills and preferences may still influence the results. In addition, observer bias may occur because the endoscopist is visually aware of the device being used. This may affect the evaluation of procedure efficiency or effectiveness. The speed of the procedure was fast because it was performed by a single experienced endoscopist, which may underestimate the difference between the two groups. Therefore, opinions from multiple practitioners regarding the ease of use are needed. The third limitation is lesion heterogeneity. This study included patients with various lesion types and sizes. Lesion characteristics, such as size, location, and histology, can significantly impact the difficulty and outcome of ESD, which introduces confounding variables. However, in the current study, no differences in lesion characteristics were observed between the groups, suggesting minimal impact on the results. Additional studies based on the location of various lesions could be considered. Moreover, no study has yet presented long-term results and cost analysis. Finally, the study was not adequately powered to definitively determine whether the new device was inferior or non-inferior to conventional methods, as we failed to show a statistically significant difference between the procedures, despite achieving the hypothesized reduction in hemostasis time. Addressing these limitations through additional and follow-up studies can improve the comprehensiveness and reliability of the results.
In summary, our study demonstrated that the new hemostatic device, Coajet, showed comparable efficacy to that of conventional hemostatic forceps (Hemograsper) for bleeding control and prevention of delayed bleeding during gastric ESD. This study provides valuable insights into the use of Coajet as an effective and safe alternative for gastric ESD procedures. Further studies involving a larger cohort are warranted to validate these findings and explore long-term outcomes and patient satisfaction with these devices.
In conclusion, Coajet can be advantageous for ESD procedures given its ability to promote hemostasis with simple contact and eliminate the need for multiple instrument changes. Moreover, this device has shown equivalent hemostatic efficacy and procedure time compared to that of Hemograsper.
Supplementary Video 1. Endoscopic submucosal dissection for early gastric cancer using Coajet (Coajet is used for marking of lesions, submucosal injections, and coagulation.).
Supplementary materials related to this article can be found online at https://doi.org/10.5946/ce.2024.295.
Fig. 1.
Flow diagram of participant enrollment and distribution into the Coajet group and Hemograsper group. ESD, endoscopic submucosal dissection. a)Mean±standard deviation.
ce-2024-295f1.jpg
Fig. 2.
(A) Hemograsper. (B) Coajet coagulation mode. (C) Coajet injection and knife mode.
ce-2024-295f2.jpg
ce-2024-295f3.jpg
Table 1.
Baseline characteristics of patients and endoscopic lesions
Characteristic Coajet group (n=28) Hemograsper group (n=28) p-value
Age (yr) 60.6±16.3 66.4±16.4 0.34
Sex 0.55
 Male 19 21 0.55
 Female 9 7
Comorbidity (hypertension or diabetes) 13 13 NA
Height (cm) 161.8±9.5 165.8±7.1 0.08
Weight (kg) 64.4±12.7 67.4±9.4 0.31
Pre-resection diagnosis 0.09
 EGC 13 12 0.09
 LGD 7 13
 HGD 8 3
EGC differentiation 7/6 10/2 0.11
 WD 7 10 0.11
 MD 6 2
Location long 0.52
 Antrum 18 13 0.52
 Lower body 8 11
 Mid body 1 3
 Upper body 1 1
Endoscopic size, long (mm) 15.9±3.8 18.1±6.4 0.12
Endoscopic ulcer 0.15
 Yes 2 0 0.15
 No 26 28
Endoscopic lesion type 0.99
 I 0 0 0.99
 IIa 11 10
 IIb 1 1
 IIc 14 15
 III 0 0
 IIa+IIc 2 2
Helicobacter pylori infection 0.64
 Yes 21 20
 No 7 8

Values are presented as mean±standard deviation unless otherwise indicated.

NA, not applicable; EGC, early gastric cancer; LGD, low-grade dysplasia; HGD, high-grade dysplasia; WD, well differentiated; MD, moderately differentiated.

Table 2.
Procedure results in both groups
Variable Coajet group (n=28) Hemograsper group (n=28) p-value
Total operation time (min) 12.4±6.7 16.0±6.9 0.05
Submucosal injection volume during procedure (mL) 20.4±8.7 21.7±8.9 0.58
Complete resection NA
 Yes 28 28
 No 0 0
SM layer fibrosis 0.08
 Yes 0 3
 No 28 25
Total hemostatic time (s) 130.4±81.5 186.6±134.5 0.06
Immediate bleeding 0.66
 Grade 0 0 1
 Grade 1 11 9
 Grade 2 12 11
 Grade 3 5 7
Delayed bleeding NA
 Yes 1 1
 No 27 27
Final histology 0.06
 WD 6 9
 MD 12 4
 High-grade dysplasia 3 3
 Low-grade dysplasia 7 12
Specimen size long (mm) 31.9±5.2 33.3±7.0 0.40
Lesion size, long (mm) 13.5±4.2 15.0±6.0 0.30
Pathologically complete resection 0.3
 Clear 27 28
 Horizontal margin 0 0
 Vertical margin 1 0
SM invasion 0.35
 pT1a 23 25
 pT1b SM1 3 3
 pT1b SM2 2 0
Lymphovascular invasion 0.55
 Yes 2 1
 No 26 27

Values are presented as mean±standard deviation or number (%) unless otherwise indicated.

NA, not applicable; SM, submucosa; WD, well-differentiated early gastric cancer; MD, moderately-differentiated early gastric cancer.

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      Related articles
      A new hemostatic device for gastric endoscopic submucosal dissection: a prospective randomized controlled trial comparing Coajet and Hemograsper in Korea
      Image Image Image
      Fig. 1. Flow diagram of participant enrollment and distribution into the Coajet group and Hemograsper group. ESD, endoscopic submucosal dissection. a)Mean±standard deviation.
      Fig. 2. (A) Hemograsper. (B) Coajet coagulation mode. (C) Coajet injection and knife mode.
      Graphical abstract

      Fig. 1.

      Fig. 2.

      Graphical abstract

      A new hemostatic device for gastric endoscopic submucosal dissection: a prospective randomized controlled trial comparing Coajet and Hemograsper in Korea
      Characteristic Coajet group (n=28) Hemograsper group (n=28) p-value
      Age (yr) 60.6±16.3 66.4±16.4 0.34
      Sex 0.55
       Male 19 21 0.55
       Female 9 7
      Comorbidity (hypertension or diabetes) 13 13 NA
      Height (cm) 161.8±9.5 165.8±7.1 0.08
      Weight (kg) 64.4±12.7 67.4±9.4 0.31
      Pre-resection diagnosis 0.09
       EGC 13 12 0.09
       LGD 7 13
       HGD 8 3
      EGC differentiation 7/6 10/2 0.11
       WD 7 10 0.11
       MD 6 2
      Location long 0.52
       Antrum 18 13 0.52
       Lower body 8 11
       Mid body 1 3
       Upper body 1 1
      Endoscopic size, long (mm) 15.9±3.8 18.1±6.4 0.12
      Endoscopic ulcer 0.15
       Yes 2 0 0.15
       No 26 28
      Endoscopic lesion type 0.99
       I 0 0 0.99
       IIa 11 10
       IIb 1 1
       IIc 14 15
       III 0 0
       IIa+IIc 2 2
      Helicobacter pylori infection 0.64
       Yes 21 20
       No 7 8
      Variable Coajet group (n=28) Hemograsper group (n=28) p-value
      Total operation time (min) 12.4±6.7 16.0±6.9 0.05
      Submucosal injection volume during procedure (mL) 20.4±8.7 21.7±8.9 0.58
      Complete resection NA
       Yes 28 28
       No 0 0
      SM layer fibrosis 0.08
       Yes 0 3
       No 28 25
      Total hemostatic time (s) 130.4±81.5 186.6±134.5 0.06
      Immediate bleeding 0.66
       Grade 0 0 1
       Grade 1 11 9
       Grade 2 12 11
       Grade 3 5 7
      Delayed bleeding NA
       Yes 1 1
       No 27 27
      Final histology 0.06
       WD 6 9
       MD 12 4
       High-grade dysplasia 3 3
       Low-grade dysplasia 7 12
      Specimen size long (mm) 31.9±5.2 33.3±7.0 0.40
      Lesion size, long (mm) 13.5±4.2 15.0±6.0 0.30
      Pathologically complete resection 0.3
       Clear 27 28
       Horizontal margin 0 0
       Vertical margin 1 0
      SM invasion 0.35
       pT1a 23 25
       pT1b SM1 3 3
       pT1b SM2 2 0
      Lymphovascular invasion 0.55
       Yes 2 1
       No 26 27
      Table 1. Baseline characteristics of patients and endoscopic lesions

      Values are presented as mean±standard deviation unless otherwise indicated.

      NA, not applicable; EGC, early gastric cancer; LGD, low-grade dysplasia; HGD, high-grade dysplasia; WD, well differentiated; MD, moderately differentiated.

      Table 2. Procedure results in both groups

      Values are presented as mean±standard deviation or number (%) unless otherwise indicated.

      NA, not applicable; SM, submucosa; WD, well-differentiated early gastric cancer; MD, moderately-differentiated early gastric cancer.

      Table 1.

      Table 2.

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