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Endoscopic submucosal dissection using a carbon dioxide laser with submucosally injected laser absorber solution (porcine model)

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Abstract

Background

Recently, endoscopic submucosal dissection (ESD) has been performed to treat early gastric cancer. The en bloc resection rate of ESD has been reported to be higher than that of conventional endoscopic mucosal resection (EMR), and ESD can resect larger lesions than EMR. However, ESD displays a higher complication rate than conventional EMR. Therefore, the development of devices that would increase the safety of ESD is desired. Lasers have been extensively studied as a possible alternative to electrosurgical tools. However, laser by itself easily resulted in perforation upon irradiation of the gastrointestinal tract. We hypothesized that performing ESD using a CO2 laser with a submucosal laser absorber could be a safe and simple treatment for early gastric cancer. To provide proof of concept regarding the feasibility of ESD using a CO2 laser with submucosally injected laser absorber solution, an experimental study in ex vivo and in vivo porcine models was performed.

Methods

Five endoscopic experimental procedures using a carbon dioxide (CO2) laser were performed in a resected porcine stomach. In addition, three endoscopic experimental procedures using a CO2 laser were performed in living pigs.

Results

In the ex vivo study, en bloc resections were all achieved without perforation and muscular damage. In addition, histological evaluations could be performed in all of the resected specimens. In the in vivo study, en bloc resections were achieved without perforation and muscular damage, and uncontrollable hemorrhage did not occur during the procedures.

Conclusions

Endoscopic submucosal dissection using a CO2 laser with a submucosal laser absorber is a feasible and safe method for the treatment of early gastric cancer.

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Acknowledgments

The authors are grateful to Satoshi Watanabe and Keiichiro Yamada, Division of Sustainable Energy and Environmental Engineering, Graduate School of Engineering, Osaka University for their important contributions to the experiments. This work was supported, in part, by grants for the Global COE Program “Global Center of Excellence for Education and Research on Signal Transduction Medicine in the Coming Generation” from the Ministry of Education, Culture, Sports, Science, and Technology of Japan and grants from the Ministry of Education, Culture, Sports, Science, and Technology of Japan, the Foundation of Advancement of International Science, and the Ministry of Health, Labour and Welfare of Japan.

Disclosures

Drs. Daisuke Obata, Yoshinori Morita, Rinna Kawaguchi, Katsunori Ishii, Hisanao Hazama, Kunio Awazu, Hiromu Kutsumi, and Takeshi Azuma have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-2, Kusnoki-cho, Chuo-ku, Kobe, Hyogo, Japan

    Daisuke Obata, Yoshinori Morita, Hiromu Kutsumi & Takeshi Azuma

  2. Division of Sustainable Energy and Environmental Engineering, Graduate School of Engineering, Osaka University, Suita, Osaka, Japan

    Rinna Kawaguchi, Katsunori Ishii, Hisanao Hazama & Kunio Awazu

Authors
  1. Daisuke Obata
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  2. Yoshinori Morita
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  3. Rinna Kawaguchi
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  4. Katsunori Ishii
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  5. Hisanao Hazama
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  6. Kunio Awazu
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  7. Hiromu Kutsumi
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  8. Takeshi Azuma
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Corresponding author

Correspondence to Takeshi Azuma.

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Obata, D., Morita, Y., Kawaguchi, R. et al. Endoscopic submucosal dissection using a carbon dioxide laser with submucosally injected laser absorber solution (porcine model). Surg Endosc 27, 4241–4249 (2013). https://doi.org/10.1007/s00464-013-3029-x

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  • DOI: https://doi.org/10.1007/s00464-013-3029-x

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