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New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos)

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Abstract

Background

Endoscopic removal of gastrointestinal tract lesions is increasingly popular around the world. We evaluated feasibility, safety, effectiveness, and user learning curve of new endoscopic platform for complex intraluminal interventions.

Methods

A novel system, consisting of expandable working chamber with two independent instrument guides (LIG), was inserted into colon. Simulated colonic lesions were removed with endoscopic submucosal (ESD) and submuscular (ESmD) dissection.

Results

In all nine in vivo models, an intraluminal chamber and its dynamic tissue retractors (via LIG) provided a stable working space with excellent visualization and adequate access to target tissue. Endoscopic platform facilitated successful completion of 11 en bloc ESDs (mean size 43.0 ± 11.3 mm, mean time 46.3 ± 41.2 min) and eight ESmD (mean size 50.0 ± 14.1 mm, mean time 48.0 ± 21.2 min). The learning curve for ESD using this platform demonstrated three phases: rapid improvement in procedural skills took place during the first three procedures (mean ESD time 98.7 ± 40.0 min). A plateau phase then occurred (procedures 4–7) with mean procedure time 42.0 ± 13.4 min (p = 0.04), followed by another sharp improvement in procedural skills (procedures 8–11) requiring only 16.3 ± 11.4 min (p = 0.03) to complete ESD. Especially dramatic (p = 0.002) was the time difference between the first three procedures (mean time 98.7 ± 40.0 min) and subsequent eight procedures (mean time 29.1 ± 17.9 min).

Conclusions

A newly developed endoscopic platform provides stable intraluminal working space, dynamic tissue retraction, and instrument triangulation, improving visualization and access to the target tissue for safer and more effective en bloc endoscopic submucosal and submuscular dissection. The learning curve for ESD was markedly facilitated by this new endoscopic platform.

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Abbreviations

LIG:

LumenR instrument guides

ESD:

Endoscopic submucosal dissection

ESmD:

Endoscopic submuscular dissection

GI:

Gastrointestinal

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Acknowledgement

The authors would like to acknowledge LumenR LLC (Oxford, Connecticut, USA) for providing devices and equipment for this study free of charge.

Disclosures

Sergey V. Kantsevoy, MD, PhD: Devices and equipment for this study were provided by LumenR LLC free of charge. Marianne Bitner, CRNA has no conflict of interest. Gregory Piskun, MD is the inventor of technology, patent’s holder.

Authors contribution

The animal study was designed by Sergey V. Kantsevoy, Marianne Bitner and Gregory Piskun. All endoscopic procedures were performed by Sergey V. Kantsevoy and Gregory Piskun. The study data were collected and analyzed by Sergey V. Kantsevoy and Marianne Bitner. The manuscript was drafted by Sergey V. Kantsevoy. The manuscript was critically reviewed by Sergey V. Kantsevoy, Marianne Bitner and Gregory Piskun. The final version of the manuscript was approved by all authors.

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Authors and Affiliations

  1. Institute for Digestive Health and Liver Diseases, Mercy Medical Center, 301 St. Paul Place, POB 7th Floor, Suite 718, Baltimore, MD, 21202, USA

    Sergey V. Kantsevoy & Marianne Bitner

  2. University of Maryland School of Medicine, Baltimore, MD, USA

    Sergey V. Kantsevoy

  3. LumenR LLC, Oxford, CT, USA

    Gregory Piskun

Authors
  1. Sergey V. Kantsevoy
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  2. Marianne Bitner
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  3. Gregory Piskun
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Corresponding author

Correspondence to Sergey V. Kantsevoy.

Electronic supplementary material

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Movie 1

ESD technique inside the LumenR chamber: Initial submucosal injection with normal saline is made at the distal end of the simulated lesion, followed by submucosal incision with the dual knife. The mucosal edge of the incision is grasped with the rat-tooth forceps and lifted, allowing access into the submucosal space. Using the rat-tooth forceps to create traction and counter-traction, the submucosal fibers under tension are cut by the dual knife to perform ESD. After completion of en bloc resection of the simulated polyp, the LumenR chamber is collapsed and removed along with colonoscope and resected specimen. (MPG 62506 kb)

Movie 2

ESmD technique inside the LumenR chamber: Initial submuscular incision is made on the distal end of the simulated lesion, separating muscular and serosal layers. The edge of the muscular layer is grasped with rat-tooth forceps and lifted, allowing access into the space between muscular and serosal layers. Using the rat-tooth forceps to create traction and counter-traction, the fibers under tension are cut by the dual knife to perform ESmD, completely dividing muscular and serosal layers. After completion of en bloc resection of the simulated polyp, the LumenR chamber is collapsed and removed along with colonoscope and resected specimen (MPG 32114 kb)

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Kantsevoy, S.V., Bitner, M. & Piskun, G. New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos). Surg Endosc 30, 3145–3151 (2016). https://doi.org/10.1007/s00464-015-4544-8

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  • DOI: https://doi.org/10.1007/s00464-015-4544-8

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