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Comparison of 3D endoscopy and conventional 2D endoscopy in gastric endoscopic submucosal dissection: an ex vivo animal study

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Abstract

Background and objectives

Conventional endoscopy provides two-dimensional (2D) information without depth information. This study compared three-dimensional (3D) endoscopy and 2D endoscopy using an endoscopic submucosal dissection (ESD) training model to evaluate the utility of 3D endoscopy.

Methods

Porcine stomach specimens (7 × 7 cm) were prepared from commercially available resected porcine stomachs and a 10-mm hypothetical lesion was marked at the center of each specimen. Specimens were individually placed in an ESD training model, and subjected to either 2D or 3D ESD. En bloc resection rate, perforation rate, incision time, dissection time, and levels of five eyestrain symptoms (fatigue, pain, blurred vision, head-heaviness, and headache; 100-mm visual analog scale) were compared between the 2D and 3D procedures. In a crossover design, 8 endoscopists each performed two 2D and two 3D procedures.

Results

All 32 lesions were resected en block, but perforation occurred in one 2D procedure. Incision time was significantly shorter in 3D ESD than in 2D ESD (102.8 ± 42.1 s vs. 135.8 ± 65.7 s, p < 0.05). Dissection time was also significantly shorter in 3D ESD than in 2D ESD (366.3 ± 187.6 s vs. 517.8 ± 282.3 s, p < 0.05). Differences in levels of all symptoms except blurred vision between before and after ESD were larger in 3D ESD than in 2D ESD.

Conclusions

Incision time and dissection time were significantly shorter in 3D ESD compared with 2D ESD, but eyestrain was increased. Depth information from 3D images appears to facilitate rapid and stable ESD maneuvers.

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Authors and Affiliations

  1. Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Kosuke Nomura, Daisuke Kikuchi, Toshiro Iizuka, Yorinari Ochiai, Yugo Suzuki, Yumiko Fukuma, Masami Tanaka, Yosuke Okamoto, Satoshi Yamashita, Akira Matsui, Toshifumi Mitani & Shu Hoteya

  2. Gastroenterology Division, Nippon Medical School, Tokyo, Japan

    Mitsuru Kaise

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  1. Kosuke Nomura
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  2. Daisuke Kikuchi
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  3. Mitsuru Kaise
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  7. Yumiko Fukuma
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  8. Masami Tanaka
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Correspondence to Kosuke Nomura.

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Kosuke Nomura, Daisuke Kikuchi, Mitsuru Kaise, Toshiro Iizuka, Yorinari Ochiai, Yugo Suzuki, Yumiko Fukuma, Masami Tanaka, Yosuke Okamoto, Satoshi Yamashita1, Akira Matsui, Toshifumi Mitani, and Shu Hoteya have no conflict of interest or financial ties to disclose.

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Nomura, K., Kikuchi, D., Kaise, M. et al. Comparison of 3D endoscopy and conventional 2D endoscopy in gastric endoscopic submucosal dissection: an ex vivo animal study. Surg Endosc 33, 4164–4170 (2019). https://doi.org/10.1007/s00464-019-06726-w

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  • DOI: https://doi.org/10.1007/s00464-019-06726-w

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