Endoscopic submucosal dissection with an additional working channel (ESD+): a novel technique to improve procedure time and safety of ESD.
Additional working channel (AWC)
Animal model
EASIE-R model
EMR+
ESD+ technique (ESD+)
Endoscopic mucosal resection (EMR)
Endoscopic submucosal dissection (ESD)
RESECT+
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
20
02
2020
accepted:
10
07
2020
pubmed:
18
7
2020
medline:
30
9
2021
entrez:
18
7
2020
Statut:
ppublish
Résumé
A new external additional working channel (AWC) was recently introduced by which endoscopic submucosal dissection (ESD) can be converted to a technique termed "ESD+ ". We aim to systematically evaluate this novel technique in flat gastric lesions and compare it to classical ESD. The study was prospectively conducted in a pre-clinical ex vivo animal model (EASIE-R simulator) with porcine stomachs. Prior to intervention, we set standardized lesions measuring 3 cm or 4 cm in antegrade as well as in retrograde positions. Overall, 64 procedures were performed by an experienced endoscopist. Both techniques were reliable and showed en bloc resection rates of 100%. Overall, ESD+ reduced time of procedure compared to ESD (24.5 vs. 32.5 min, p = 0.025*). Particularly, ESD+ was significantly faster in retrograde lesions with a median of 22.5 vs. 34.0 min in 3 cm retrograde lesions (p = 0.002*) and 34.5 vs. 41.0 min (p = 0.011*) in 4 cm retrograde lesions. There were 0 perforations with both techniques. In ESD+ , 1 muscularis damage occurred (3.13%) compared to 6 muscularis damages with ESD (18.75%, p = 0.045*). By its grasp-and-mobilize technique, ESD+ allows potentially faster and safer resections of flat gastric lesions compared to conventional ESD in an ex vivo porcine model. The potential advantages of ESD+ in terms of procedure time may be particularly relevant for difficult lesions in retrograde positions.
Sections du résumé
BACKGROUND AND AIMS
A new external additional working channel (AWC) was recently introduced by which endoscopic submucosal dissection (ESD) can be converted to a technique termed "ESD+ ". We aim to systematically evaluate this novel technique in flat gastric lesions and compare it to classical ESD.
METHODS
The study was prospectively conducted in a pre-clinical ex vivo animal model (EASIE-R simulator) with porcine stomachs. Prior to intervention, we set standardized lesions measuring 3 cm or 4 cm in antegrade as well as in retrograde positions.
RESULTS
Overall, 64 procedures were performed by an experienced endoscopist. Both techniques were reliable and showed en bloc resection rates of 100%. Overall, ESD+ reduced time of procedure compared to ESD (24.5 vs. 32.5 min, p = 0.025*). Particularly, ESD+ was significantly faster in retrograde lesions with a median of 22.5 vs. 34.0 min in 3 cm retrograde lesions (p = 0.002*) and 34.5 vs. 41.0 min (p = 0.011*) in 4 cm retrograde lesions. There were 0 perforations with both techniques. In ESD+ , 1 muscularis damage occurred (3.13%) compared to 6 muscularis damages with ESD (18.75%, p = 0.045*).
CONCLUSIONS
By its grasp-and-mobilize technique, ESD+ allows potentially faster and safer resections of flat gastric lesions compared to conventional ESD in an ex vivo porcine model. The potential advantages of ESD+ in terms of procedure time may be particularly relevant for difficult lesions in retrograde positions.
Identifiants
pubmed: 32676726
doi: 10.1007/s00464-020-07808-w
pii: 10.1007/s00464-020-07808-w
pmc: PMC8195965
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3506-3512Références
Ferlitsch M, Moss A, Hassan C et al (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 49:270–297
doi: 10.1055/s-0043-102569
Wang J, Zhang XH, Ge J et al (2014) Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis. World J Gastroenterol 20:8282–8287
doi: 10.3748/wjg.v20.i25.8282
Holmes I, Friedland S (2016) Endoscopic mucosal resection versus endoscopic submucosal dissection for large polyps: a Western Colonoscopist's view. Clin Endosc 49:454–456
doi: 10.5946/ce.2016.077
Zhan T, Hielscher T, Hahn F et al (2016) Risk factors for local recurrence of large, flat colorectal polyps after endoscopic mucosal resection. Digestion 93:311–317
doi: 10.1159/000446364
Meier B, Caca K, Fischer A et al (2017) Endoscopic management of colorectal adenomas. Ann Gastroenterol 30:592–597
pubmed: 29118553
pmcid: 5670278
Wedi E, Knoop RF, Jung C et al (2019) Use of an additional working channel for endoscopic mucosal resection (EMR+) of a pedunculated sessile serrated adenoma in the sigmoid colon. Endoscopy. https://doi.org/10.1055/a-0809-4814
doi: 10.1055/a-0809-4814
pubmed: 30736088
Wedi E, Knoop R, Jung C et al (2019) EMR + with the AWC improves endoscopic resection speed compared to ESD: a porcine ex-vivo pilot study. Minim Invasive Ther Allied Technol. https://doi.org/10.1080/13645706.2019.1673778:1-8
doi: 10.1080/13645706.2019.1673778:1-8
pubmed: 31597491
Knoop RF, Wedi E, Petzold G et al (2020) Endoscopic mucosal resection with an additional working channel (EMR+) in a porcine ex vivo model: a novel technique to improve en bloc resection rate of snare polypectomy. Endosc Int Open 8:E99–E104
doi: 10.1055/a-0996-8050
Walter B, Schmidbaur S, Krieger Y et al (2019) Improved endoscopic resection of large flat lesions and early cancers using an external additional working channel (AWC): a case series. Endosc Int Open 7:E298–E301
doi: 10.1055/a-0824-6912
Gotoda T (2005) A large endoscopic resection by endoscopic submucosal dissection procedure for early gastric cancer. Clin Gastroenterol Hepatol 3:S71–73
doi: 10.1016/S1542-3565(05)00251-X
Repici A, Hassan C, Carlino A et al (2010) Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc 71:715–721
doi: 10.1016/j.gie.2009.11.020
Odagiri H, Yasunaga H, Matsui H et al (2017) Hospital volume and adverse events following esophageal endoscopic submucosal dissection in Japan. Endoscopy 49:321–326
doi: 10.1055/s-0043-119982
Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al (2015) Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 47:829–854
doi: 10.1055/s-0034-1392882
Ono S, Fujishiro M, Niimi K et al (2009) Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc 70:860–866
doi: 10.1016/j.gie.2009.04.044
Scholvinck DW, Goto O, Bergman JJ et al (2015) The efficacy of an endoscopic grasp-and-traction device for gastric endoscopic submucosal dissection: an ex vivo comparative study (with video). Clin Endosc 48:221–227
doi: 10.5946/ce.2015.48.3.221
Schöfl R, Buchmeier B, Hauder G (2006) Adaptation of the erlangen active simulator for interventional endoscopy (EASIE) model for transmural pancreatic pseudocyst drainage. Endoscopy 38:100
doi: 10.1055/s-2006-925037
Hochberger J, Matthes K, Maiss J et al (2005) Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone. Gastrointest Endosc 61:204–215
doi: 10.1016/S0016-5107(04)02471-X
Wedi E, Orlandini B, Gromski M et al (2018) Full-thickness resection device for complex colorectal lesions in high-risk patients as a last-resort endoscopic treatment: initial clinical experience and review of the current literature. Clin Endosc 51:103–108
doi: 10.5946/ce.2017.093
Meining A (2015) Endoscopic full-thickness resection: the logical step toward more extended endoscopic oncologic resections? Endoscopy 47:101–102
doi: 10.1055/s-0034-1391372
Hochberger J, Kruse E, Wedi E et al (2011) Training in endoscopic mucosal resection and endoscopic submucosal dissection. In: Cohen J (ed) Successful gastrointestinal endoscopy. Wiley-Blackwell, Oxford, pp 204–237
doi: 10.1002/9781444397772.ch18
Kantsevoy SV, Bitner M, Piskun G (2016) New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos). Surg Endosc 30:3145–3151
doi: 10.1007/s00464-015-4544-8
Sanchez-Yague A, Kaltenbach T, Yamamoto H et al (2012) The endoscopic cap that can (with videos). Gastrointest Endosc 76(169–178):e161–162
Rieder E, Makris KI, Martinec DV et al (2011) The suture-pulley method for endolumenal triangulation in endoscopic submucosal dissection. Endoscopy 43(Suppl 2 UCTN):E319–E320
doi: 10.1055/s-0030-1256774
Kondo H, Gotoda T, Ono H et al (2004) Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer. Gastrointest Endosc 59:284–288
doi: 10.1016/S0016-5107(03)02533-1
Gotoda T, Oda I, Tamakawa K et al (2009) Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest Endosc 69:10–15
doi: 10.1016/j.gie.2008.03.1127
Aihara H, Kumar N, Ryou M et al (2014) Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video). Gastrointest Endosc 80:495–502
doi: 10.1016/j.gie.2014.01.050
Imaeda H, Hosoe N, Ida Y et al (2009) Novel technique of endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia. Dig Endosc 21:122–127
doi: 10.1111/j.1443-1661.2009.00842.x
Oka S, Tanaka S, Kaneko I et al (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883
doi: 10.1016/j.gie.2006.03.932
Park YM, Cho E, Kang HY et al (2011) The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 25:2666–2677
doi: 10.1007/s00464-011-1627-z
Lian J, Chen S, Zhang Y et al (2012) A meta-analysis of endoscopic submucosal dissection and EMR for early gastric cancer. Gastrointest Endosc 76:763–770
doi: 10.1016/j.gie.2012.06.014
Facciorusso A, Antonino M, Di Maso M et al (2014) Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: a meta-analysis. World J Gastrointest Endosc 6:555–563
doi: 10.4253/wjge.v6.i11.555
Hochberger J, Köhler P, Kruse E et al (2013) Endoscopic submucosal dissection. Internist (Berl) 54:287–301
doi: 10.1007/s00108-012-3179-2
von Renteln D, Schmidt A, Vassiliou MC et al (2010) Endoscopic mucosal resection using a grasp-and-snare technique. Endoscopy 42:475–480
doi: 10.1055/s-0029-1244121
Shetty A, Suarez AL, Dufault DL et al (2016) Endoscopic mucosal resection with grasp-and-snare technique for challenging lesions. Gastrointest Endosc 84:738–739
doi: 10.1016/j.gie.2016.04.002
de Melo SW, Cleveland P Jr., Raimondo M et al (2011) Endoscopic mucosal resection with the grasp-and-snare technique through a double-channel endoscope in humans. Gastrointest Endosc 73:349–352
doi: 10.1016/j.gie.2010.10.030
Yonezawa J, Kaise M, Sumiyama K et al (2006) A novel double-channel therapeutic endoscope ("R-scope") facilitates endoscopic submucosal dissection of superficial gastric neoplasms. Endoscopy 38:1011–1015
doi: 10.1055/s-2006-944779
Jung Y, Kato M, Lee J et al (2013) Prospective, randomized comparison of a prototype endoscope with deflecting working channels versus a conventional double-channel endoscope for rectal endoscopic submucosal dissection in an established experimental simulation model (with video). Gastrointest Endosc 78:756–762
doi: 10.1016/j.gie.2013.04.193