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Endoscopy 2013; 45(08): 661-666
DOI: 10.1055/s-0033-1344126
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Can mechanical balloon dissection be applied to cleave fibrotic submucosal tissues? A pilot study in a porcine model

A. Dobashi
1   Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
,
K. Sumiyama
1   Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
,
C. J. Gostout
2   Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
,
T. R. Ohya
1   Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
,
M. Kobayashi
1   Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
,
H. Imazu
1   Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
,
H. Tajiri
1   Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
3   Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

submitted: 30 October 2012

accepted after revision: 26 March 2013

Publication Date:
27 June 2013 (online)

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Background and study aims: Removal of a lesion containing an ulcer scar is one of the most challenging applications of endoscopic submucosal dissection (ESD). The present study examined whether a novel balloon dissector could cleave fibrotic submucosal tissue beneath ulcer scars.

Methods: Six pigs were studied. Endoscopic mucosal resection (EMR) with ligation was performed at 7 or 8 sites in the stomach for each animal; 4 weeks later, 23 sites with a visible scar were selected for submucosal dissection. The procedure involved first creating a submucosal fluid cushion (SFC) by injecting either saline mixed with mesna or pure saline. A slender, compliant balloon with a diameter of 8, 13, or 18 mm was inserted into the SFC. The balloon was unfolded and thrust forward to cleave the fibrotic submucosa over approximately 5 cm.

Results: Fibrotic submucosa was dissected within 90 seconds in 17 of 23 attempts. Isolating the ulcer scar from the muscularis with the SFC prior to balloon dissection and using a thinner balloon catheter both ensured a better dissection.

Conclusions: The fibrotic submucosa underlying post-EMR scars can be dissected with the novel balloon dissector, although the technique is less effective in cases with no sign of lifting.

 

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