scholarly journals Usefulness of 3-Dimensional Flexible Endoscopy in Esophageal Endoscopic Submucosal Dissection in an Ex Vivo Animal Model

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Kazutoshi Higuchi ◽  
Mitsuru Kaise ◽  
Hiroto Noda ◽  
Go Ikeda ◽  
Teppei Akimoto ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Ex Vivo ◽  
Flexible Endoscopy ◽  
Procedure Time ◽  
3D Vision ◽  
Submucosal Dissection ◽  
Sense Of Security ◽  
Mucosal Incision ◽  
2D And 3D

Background and Aims. Three-dimensional (3D) rigid endoscopy has been clinically introduced in surgical fields to enable safer and more accurate procedures. To explore the feasibility of 3D flexible endoscopy, we conducted a study comparing 2-dimensional (2D) and 3D visions for the performance of esophageal endoscopic submucosal dissection (ESD). Methods. Six endoscopists (3 experts and 3 trainees) performed ESD of target lesions in isolated porcine esophagus using a prototype 3D flexible endoscope under 2D or 3D vision. Study endpoints were procedure time, speed of mucosal incision and submucosal dissection, number of technical adverse events (perforation, muscle layer damage, and sample damage), and degree of sense of security, fatigue, and eye strain. Results. Procedure time and speed of mucosal incision/submucosal dissection were equivalent for 2D and 3D visions in both experts and trainees. The number of technical adverse events using 2D vision (mean [standard deviation], 3.5 [4.09]) tended to be higher than that using 3D vision in trainees (1.33 [2.80]; P=.06). In experts, 2D and 3D visions were equivalent. The degree of sense of security using 3D vision (3.67 [0.82]) was significantly higher than that using 2D vision (2.67 [0.52]) in trainees (P=.04), but was equivalent in experts. The degree of eye strain using 3D vision (3.00 [0.00]) was significantly higher than that using 2D vision (2.17 [0.41]) in trainees, but was equivalent in experts. Conclusions. 3D vision improves the sense of security during ESD and may reduce technical errors, especially in trainees, indicating the feasibility of a clinical trial of ESD under 3D vision.

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

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.

scholarly journals Ex vivo porcine model study on the treatment outcomes of scissor-type knife versus needle-type knife in endoscopic submucosal dissection performed by trainees

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ryoji Ichijima ◽  
Mitsuru Esaki ◽  
Shun Yamakawa ◽  
Yosuke Minoda ◽  
Sho Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Treatment Outcomes ◽  
Subgroup Analysis ◽  
Porcine Model ◽  
Ex Vivo ◽  
Procedure Time ◽  
Needle Type ◽  
Submucosal Dissection ◽  
Muscular Injury ◽  
Total Procedure

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.

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

Endoscopy ◽  
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.

scholarly journals Two electrosurgical endo-knives for endoscopic submucosal dissection of colorectal superficial neoplasms: a prospective randomized study

2017 ◽  
Vol 05 (08) ◽  
pp. E729-E735 ◽  
Author(s):  
Yuusaku Sugihara ◽  
Keita Harada ◽  
Yoshiro Kawahara ◽  
Daisuke Takei ◽  
Shiho Takashima ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Controlled Trial ◽  
Randomized Study ◽  
Procedure Time ◽  
Related Factors ◽  
Submucosal Dissection ◽  
Total Procedure Time ◽  
Mucosal Incision ◽  
The Difference ◽  
Total Procedure

Abstract Background and study aims Few studies have directly compared endo-knives for endoscopic submucosal dissection (ESD) in humans. We compared the performances of the Mucosectom2 and SB knife Jr. Patients and methods Two trainee endoscopists performed ESD of 36 lesions in this prospective, randomized controlled trial. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection using the Mucosectom2 were performed in 1 group. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection with a SB knife Jr. were performed in the other group. The primary outcome was the ESD procedure time. Secondary outcomes were total procedure time, self-completion rates, and adverse events. Results ESD time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (57 ± 32 min vs. 61 ± 44 min, respectively; P = 0.94). Total procedure time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (81 ± 42 min vs. 82 ± 51 min, respectively; P = 0.85). The trainee self-completion rate was slightly higher in SB knife Jr. patients than in Mucosectom2 patients, although the difference was not significant (94 % vs. 100 %, respectively; P = 0.959). Fewer hemostatic procedures using the Coagrasper were performed in Mucosectom2 patients than in SB knife Jr. patients, although the difference was not significant (0.62 vs. 0.7, respectively; P = 0.432). Conclusions Mucosectom2 and SB knife Jr. did not significantly differ in performance for colorectal ESD to safely and reliably enhance ESD. Knife selection is not as important for learning colorectal ESD as patient- and lesion-related factors.

scholarly journals Esophageal Endoscopic Submucosal Dissection Assisted by an Overtube with a Traction Forceps: An Animal Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ken Ohata ◽  
Kuangi Fu ◽  
Eiji Sakai ◽  
Kouichi Nonaka ◽  
Tomoaki Tashima ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Animal Study ◽  
Ex Vivo ◽  
Target Lesion ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Muscular Injury ◽  
Mucosal Incision ◽  
Novel Method

Esophageal endoscopic submucosal dissection (ESD) is technically difficult. To make it safer, we developed a novel method using overtube with a traction forceps (OTF) for countertraction during submucosal dissection. We conducted anex vivoanimal study and compared the clinical outcomes between OTF-ESD and conventional method (C-ESD). A total of 32 esophageal ESD procedures were performed by four beginner and expert endoscopists. After circumferential mucosal incision for the target lesion, structured as the isolated pig esophagus 3 cm long, either C-ESD or OTF-ESD was randomly selected for submucosal dissection. All the ESD procedures were completed as en bloc resections, while perforation only occurred in a beginner’s C-ESD procedure. The dissection time for OTF-ESD was significantly shorter than that for C-ESD for both the beginner and expert endoscopists (22.8±8.3 min versus7.8±4.5 min,P<0.001, and11.3±4.4 min versus5.9±2.5 min,P=0.01, resp.). The frequency and volume of the submucosal injections were significantly smaller for OTF-ESD than for C-ESD (1.3±0.6times versus2.9±1.5times,P<0.001, and5.3±2.8 mL versus15.6±7.3 mL,P<0.001, resp.). Histologically, muscular injury was more common among the C-ESD procedures (80% versus 13%,P=0.009). Our results indicated that the OTF-ESD technique is useful for the safe and easy completion of esophageal ESD.

scholarly journals Ex vivo porcine model study on the treatment outcomes of scissor-type knife versus needle-type knife in endoscopic submucosal dissection performed by trainees

2020 ◽  
Author(s):  
Ryoji Ichijima ◽  
Mitsuru Esaki ◽  
Shun Yamakawa ◽  
Yosuke Minoda ◽  
Sho Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Treatment Outcomes ◽  
Subgroup Analysis ◽  
Porcine Model ◽  
Ex Vivo ◽  
Procedure Time ◽  
Needle Type ◽  
Submucosal Dissection ◽  
Muscular Injury ◽  
Total Procedure

Abstract BackgroundEndoscopic 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. MethodsThis 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.ResultsEight trainees had an experience of over 1,000 endoscopies (senior trainee: S-Trainee), whereas the others had an experience of less than 1,000 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).ConclusionsThis study revealed that trainees, particularly those who have experienced less than 1,000 endoscopies, should opt for the scissor-type knife to perform ESD.

scholarly journals Ex vivo porcine model study on the treatment outcomes of scissor-type knife versus needle-type knife in endoscopic submucosal dissection performed by trainees

2020 ◽  
Author(s):  
Ryoji Ichijima ◽  
Mitsuru Esaki ◽  
Shun Yamakawa ◽  
Yosuke Minoda ◽  
Sho Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Treatment Outcomes ◽  
Subgroup Analysis ◽  
Porcine Model ◽  
Ex Vivo ◽  
Procedure Time ◽  
Needle Type ◽  
Submucosal Dissection ◽  
Muscular Injury ◽  
Total Procedure

Abstract BackgroundEndoscopic 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.MethodsThis 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.ResultsEight trainees had an experience of over 1,000 endoscopies (senior trainee: S-Trainee), whereas the others had an experience of less than 1,000 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).ConclusionsThis study revealed that trainees, particularly those who have experienced less than 1,000 endoscopies, should opt for the scissor-type knife to perform ESD.

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