An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video)

Abstract Background Endoscopic submucosal dissection (ESD) for gastrointestinal neoplasms can be technically difficult for trainee endoscopists. Presently, there is no consensus for trainees to select the endo-knife type in ESD. Therefore, we conducted a comparison study of treatment outcomes between scissors-type and needle-type knives in ESD performed by trainees in an ex vivo porcine model. Methods This study was conducted on trainee endoscopists who participated in ESD hands-on seminars held in August 2018 and September 2019. A total of 22 trainees from 13 institutions were divided into two groups according to their endoscopic experience. Under expert supervision, each trainee performed two ESDs in porcine models, namely, scissor-type knife (ESD-S) and needle-type knife (ESD-N). The efficacy and safety, including the procedure time and rates of self-completion, en bloc resection, and complications, were compared between ESD-S and ESD-N. In subgroup analysis, we also investigated the predictors associated with the difficulty of ESD for trainees using multivariate logistic regression analysis. Results Eight trainees had an experience of over 1000 endoscopies (senior trainee: S-Trainee), whereas the others had an experience of less than 1000 endoscopies (junior trainee: J-Trainee). Among the S-Trainees, no significant differences were observed in any treatment outcome between ESD-S and ESD-N. Among the J-Trainees, the total procedure and mucosal incision times were significantly shorter in ESD-S than in ESD-N [total procedure time: 16.5 min (range 10.0–31.0) vs. 22.3 min (range 10.0–38.0), P = 0.018; circumferential incision time: 10.0 min (range 6–16) vs. 17.0 min (range 5.0–31.5); P = 0.019]. Regarding complications, muscular injury occurred in two patients during ESD-N performed by J-Trainees; however, no muscular injury occurred during ESD-S. In subgroup analysis, ESD-N was an independent predictive factor of difficult ESD (odds ratio 5.28, 95% confidence interval 1.25–22.30; P = 0.024). Conclusions This study revealed that trainees, particularly those who have experienced less than 1000 endoscopies, should opt for the scissor-type knife to perform ESD.

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A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study

Endoscopy ◽

10.1055/a-1120-8533 ◽

2020 ◽

Vol 52 (09) ◽

pp. 780-785

Author(s):

Seiichiro Abe ◽

Yutaka Saito ◽

Yusaku Tanaka ◽

Mai Ego ◽

Fumito Yanagisawa ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Ex Vivo ◽

Barbed Suture ◽

Procedure Time ◽

Closure Rate ◽

Needle Holder ◽

Lower Rectum ◽

Submucosal Dissection ◽

Mucosal Defect ◽

Colorectal Endoscopic Submucosal Dissection

Abstract Background This study aimed to demonstrate the feasibility of endoscopic hand-suturing (EHS) and attainability of sustained closure after colorectal endoscopic submucosal dissection (ESD). Methods EHS was defined as uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS. Repeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates. Results 11 lesions were included. Median size of the mucosal defect was 38 mm (range 25 – 55 mm) and the lesion characteristics were as follows: lower rectum/upper rectum/ascending colon/cecum = 3/3/2/3, and 0-IIa/0-Is + IIa/others = 5/4/2. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73 %. Median procedure time for suturing was 56 minutes (range 30 – 120 minutes) and median number of stitches was 8 (range 6 – 12). Sustained closure and post-ESD bleeding rates were 64 % and 9 %, respectively. Conclusions EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable.

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Sa1578 a Magnetic Counter-Traction Device Facilitates Colorectal Endoscopic Submucosal Dissection (ESD) by Improving Procedure Time and Parameters of Procedure-Related Demand

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2014.05.196 ◽

2014 ◽

Vol 79 (5) ◽

pp. AB261

Author(s):

Hiroyuki Aihara ◽

Marvin Ryou ◽

Nitin Kumar ◽

Michele B. Ryan ◽

Christopher C. Thompson

Keyword(s):

Endoscopic Submucosal Dissection ◽

Procedure Time ◽

Submucosal Dissection ◽

Traction Device ◽

Colorectal Endoscopic Submucosal Dissection

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Scissor-type knife improves the safety of endoscopic submucosal dissection (ESD) among endoscopists without experience in ESD: a randomized ex vivo study

Endoscopy International Open ◽

10.1055/a-1487-5469 ◽

2021 ◽

Vol 09 (08) ◽

pp. E1207-E1213

Author(s):

Kavel Visrodia ◽

Tarek Sawas ◽

Liam Zakko ◽

Juan Reyes Genere ◽

Cadman Leggett ◽

...

Keyword(s):

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Muscle Injury ◽

Ex Vivo ◽

En Bloc Resection ◽

Bloc Resection ◽

Lower Proportion ◽

Procedure Time ◽

En Bloc ◽

Submucosal Dissection

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is technically challenging, difficult to learn, and carries a substantial risk of perforation, all of which remain significant barriers to its adoptability. We aimed to determine whether use of a novel scissor-type knife improved efficacy and safety among novice performers of ESD. Materials and methods Following a brief didactic session on ESD, participants performed ESD of two lesions (2 cm diameter) in an ex vivo porcine gastric model. One resection was performed with a conventional knife and the other with the scissor knife (order of knife randomized). We recorded procedure time, successful en bloc resection, and adverse events (including full-thickness perforation and muscle injury) for each dissection. Participants completed a post-study survey. Results 10 endoscopists (8 trainees, 2 staff) considered novices in ESD participated. Compared with the conventional knife, use of the scissor knife was associated with a significantly shorter time to completion of submucosal dissection (mean 6.2 [SD 5.6] vs. 15.6 [SD 15.6] minutes; P = 0.04) and total procedure time was not significantly different (22.1 [SD 13.3] vs. 24.9 [SD 26.5] minutes; P = 0.65). Scissor knife use was also associated with a significantly lower proportion of perforation and/or muscle injury (10.0 % vs. 70.0 %; P < 0.01) and proportion of muscle injury alone (10.0 % vs. 60.0 %; P = 0.02). Conclusions Among novices performing ESD on an ex vivo animal model, use of a scissor knife was associated with a significantly lower proportion of adverse events without prolonging procedure time. Scissor-type knives may improve ESD safety, at least among novices.

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Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience

BMC Gastroenterology ◽

10.1186/s12876-021-02085-w ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Hiroaki Matsui ◽

Naoto Tamai ◽

Toshiki Futakuchi ◽

Shunsuke Kamba ◽

Akira Dobashi ◽

...

Keyword(s):

Pilot Study ◽

Endoscopic Submucosal Dissection ◽

Clinical Outcomes ◽

Ex Vivo ◽

En Bloc Resection ◽

Bloc Resection ◽

R0 Resection ◽

En Bloc ◽

Submucosal Dissection ◽

Traction Device

Abstract Background Endoscopic submucosal dissection (ESD) is technically difficult and requires considerable training. The authors have developed a multi-loop traction device (MLTD), a new traction device that offers easy attachment and detachment. We aimed to evaluate the utility of MLTD in ESD. Methods This ex vivo pilot study was a prospective, block-randomized, comparative study of a porcine stomach model. Twenty-four lesions were assigned to a group that undertook ESD using the MLTD (M-ESD group) and a group that undertook conventional ESD (C-ESD group) to compare the speed of submucosal dissection. In addition, the data of consecutive 10 patients with eleven gastric lesions was collected using electronic medical records to clarify the inaugural clinical outcomes of gastric ESD using MLTD. Results The median (interquartile range) speed of submucosal dissection in the M-ESD and C-ESD groups were 141.5 (60.9–177.6) mm2/min and 35.5 (20.8–52.3) mm2/min, respectively; submucosal dissection was significantly faster in the M-ESD group (p < 0.05). The rate of en bloc resection and R0 resection was 100% in both groups, and there were no perforation in either group. The MLTD attachment time was 2.5 ± 0.9 min and the MLTD extraction time was 1.0 ± 1.1 min. Clinical outcomes of MLTD in gastric ESD were almost the same as those of ex vivo pilot study. Conclusions MLTD increased the speed of submucosal dissection in ESD and was similarly effective when used by expert and trainee endoscopists without perforation. MLTD can potentially ensure a safer and faster ESD.

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