Abstract
Background
Steady pressure automatically controlled endoscopy (SPACE) is a new modality that eliminates on-demand insufflation but enables automatic insufflation in the gastrointestinal tract. Though its use in porcine esophageal ESD was reported to be promising, its applicability and potential effectiveness to gastric procedures have not been evaluated.
Objective
The aims were (1) to evaluate feasibility and safety of SPACE in the stomach, and (2) to assess its potential advantages over conventional endoscopy in preventing “blind insufflation”-related complications.
Design
A multicenter randomized preclinical animal study.
Setting
Laboratories at three universities.
Interventions
Experiment 1: Gastric ESD was attempted in the swine (n = 17), under either SPACE or manual insufflation. Experiment 2: Gastroscopy was performed for 10 min in the perforated stomach (n = 10) under either SPACE or manual insufflation.
Main outcome measurements
Experiment 1: ESD time, energy device activation time, number of forceps exchanges, specimen size, en block resection rate, vital signs and any intraoperative adverse events. Experiment 2: Intra-gastric and intra-abdominal pressures, vital signs, and any adverse events.
Results
Experiment 1: Gastric ESD was completed in all animals. ESD time tended to be shorter in SPACE than in the control, though the difference was not significant (p = 0.18). Experiment 2: Although both intra-gastric and intra-abdominal pressures remained within preset values in SPACE, they showed excessive elevation in control.
Limitations
An animal study with small sample size.
Conclusions
SPACE is feasible and safe for complicated and lengthy procedures such as gastric ESD, and is potentially effective in preventing serious consequences related to excessive blind insufflation.
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Abbreviations
- CO2 :
-
Carbon dioxide
- ESD:
-
Endoscopic submucosal dissection
- SPACE:
-
Steady pressure automatically controlled endoscopy
- ACS:
-
Abdominal compartment syndrome
- EtCO2 :
-
End-tidal carbon dioxide
- SpO2 :
-
Percutaneous oxygen saturation
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Funding
The co-author Kiyokazu Nakajima has received research funding from Top, Co., Ltd. (Tokyo, Japan) and Fujifilm Corp. (Tokyo, Japan).
Disclosures
Authors Takuya Yamada, Masashi Hirota, Shusaku Tsutsui, Motohiko Kato, Tsuyoshi Takahashi, Kazuhiro Yasuda, Kazuki Sumiyama, Masahiko Tsujii, Tetsuo Takehara, Masaki Mori, Yuichiro Doki and Kiyokazu Nakajima have no conflicts of interest or financial ties to disclose.
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Takuya Yamada and Masashi Hirota have contributed equally to this study.
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Yamada, T., Hirota, M., Tsutsui, S. et al. Gastric endoscopic submucosal dissection under steady pressure automatically controlled endoscopy (SPACE); a multicenter randomized preclinical trial. Surg Endosc 29, 2748–2755 (2015). https://doi.org/10.1007/s00464-014-4001-0
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DOI: https://doi.org/10.1007/s00464-014-4001-0