Colorectal endoscopic submucosal dissection using novel articulating devices: a comparative study in a live porcine model
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Background and aims
Colonic endoscopic submucosal dissection (ESD) is time-consuming and bears a high risk of perforation. The aim of the present study was to compare the safety and efficacy between novel articulating devices and conventional ESD in live porcine colon models.
Thirty ESDs in ten pigs were carried out at three different locations (15, 25, and 35 cm from the anus) by the conventional method (n = 15) and by the new method (n = 15). Procedure times, adverse events (perforation, bleeding), and damage to the muscular layer were recorded, and the ESD time per unit area of the specimens was calculated.
The perforation rate using the conventional method was 6.7% (1/15), whereas that using the new method was 0.0%. The number of sites of muscular damage was significantly lower in the new than conventional method (6 vs. 37, respectively; P = 0.024). The mean procedure time was significantly shorter in the new than conventional method (4.6 ± 2.0 vs. 7.0 ± 4.1 min/cm2, respectively; P = 0.042).
Use of the new ESD method allows for reduced adverse events and a shortened resection time.
KeywordsEndoscopic submucosal dissection ESD Novel device Articulating device Standard endoscope Colon
Endoscopic submucosal dissection
We thank Angela Morben, DVM, ELS, from Edanz Group (http://www.edanzediting.com/ac) for editing a draft of this manuscript.
YO: contributed to the study concept and design, the acquisition, analysis and interpretation of the data, the statistical analysis, and the initial drafting of the manuscript; RN: contributed to the study concept and design, the acquisition, the analysis and interpretation of the data, the drafting of the manuscript, and the critical revision of the manuscript for important intellectual content; SN, JA, SO, TM, ME, TI, KO, TA, TI: contributed to data collection and interpretation, and critically reviewed the manuscript; TK and MH: contributed to the critical revision of the manuscript for important intellectual content and approved the final draft for submission. All authors approved the final version of the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Compliance with ethical standards
Drs. Okamoto, Nakadate, Nakamura, Arata, Ohuchida, and Hashizume have received research funding from Hogy Medical Co. Ltd., Japan. Drs. Oguri, Moriyama, Esaki, Iwasa, Akahoshi, Ikeda and Kitazono have no conflicts of interest or financial ties to disclose.
Supplementary Video 1 The first part of the video shows the dexterous movement, quick response, and small bending radius of the novel articulating devices. The second part of the video shows the endoscopic camera view during an in vivo porcine colorectal ESD. (MPG 45344 KB)
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