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

Kavel Visrodia; Tarek Sawas; Liam Zakko; Juan Reyes Genere; Cadman Leggett; Lori Lutzke; Kenneth K. Wang

doi:10.1055/a-1487-5469

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(08): E1207-E1213
DOI: 10.1055/a-1487-5469

Original article

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

Authors

Kavel Visrodia

¹Digestive and Liver Diseases, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, United States
Tarek Sawas

²Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas, United States
Liam Zakko

³Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Juan Reyes Genere

⁴Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, United States
Cadman Leggett

³Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Lori Lutzke

³Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
Kenneth K. Wang

³Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States

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.

Full Text

References

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