A novel endoscopic submucosal dissection technique with robust and adjustable tissue traction
submitted 08 July 2013
accepted after revision 12 July 2013
28 January 2014 (eFirst)
Background and study aims: A novel esophageal endoscopic submucosal dissection (ESD) technique was devised using a newly developed overtube to achieve adequate tissue traction. The aim of this study was to evaluate the feasibility and safety of this new full-traction ESD (tESD) technique.
Methods: The key feature of tESD is tissue traction by grasping forceps, which is passed through the built-in side channel of the overtube. The strength and direction of traction is controlled by rotating the overtube and by adjusting its depth. The en bloc resection rate, procedure time, adverse events, and dissected area per minute were evaluated in a porcine model (n = 10) and compared with those of conventional ESD (n = 10).
Results: tESD provided robust and adjustable tissue traction during the procedure. En bloc resection was accomplished in all lesions with no complications. Median procedure time was similar to that of the conventional technique (25 vs. 27 minutes; P = 0.4723) but the submucosal injection catheter was used less often (1.5 vs. 6; P < 0.01).
Conclusions: tESD might contribute to more efficient esophageal ESD by providing adequate tissue traction. This inexpensive technique may become an attractive option in esophageal ESD.
* These authors contributed equally to this work.
- 1 Othman MO, Wallace MB. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in 2011, a Western perspective. Clin Res Hepatol Gastroenterol 2011; 35: 288-294
- 2 Matsui N, Akahoshi K, Nakamura K et al. Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms: a technical review. World J Gastrointest Endosc 2012; 4: 123-136
- 3 Okamoto K, Okamura S, Muguruma N et al. Endoscopic submucosal dissection for early gastric cancer using a cross-counter technique. Surg Endosc 2012; 26: 3676-3681
- 4 Deprez PH, Bergman JJ, Meisner S et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy 2010; 42: 853-858
- 5 Nakajima K, Moon JH, Tsutsui S et al. Esophageal submucosal dissection under steady pressure automatically controlled endoscopy (SPACE): a randomized preclinical trial. Endoscopy 2012; 44: 1139-1148
- 6 Yamamoto H, Kawata H, Sunada K et al. Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 2003; 35: 690-694
- 7 Gotoda T, Oda I, Tamakawa K et al. Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest Endosc 2009; 69: 10-15
- 8 Imaeda H, Iwao Y, Ogata H et al. A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps. Endoscopy 2006; 38: 1007-1010
- 9 Jeon WJ, You IY, Chae HB et al. A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection. Gastrointest Endosc 2009; 69: 29-33
- 10 Li CH, Chen PJ, Chu HC et al. Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). Gastrointest Endosc 2011; 73: 163-167