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Surgical Endoscopy

, Volume 32, Issue 6, pp 2902–2906 | Cite as

Comparison of ENDO CUT mode and FORCED COAG mode for the formation of stricture after esophageal endoscopic submucosal dissection in an in vivo porcine model

  • Masamichi Arao
  • Ryu Ishihara
  • Yusuke Tonai
  • Taro Iwatsubo
  • Satoki Shichijyo
  • Noriko Matsuura
  • Hiroko Nakahira
  • Sachiko Yamamoto
  • Yoji Takeuchi
  • Koji Higashino
  • Noriya Uedo
  • Shinichi Nakatsuka
Article

Abstract

Background and study aim

Stricture is a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. To date, various methods have been developed to prevent stricture. However, the mechanism by which different electrosurgical unit (ESU) modes affect the formation of post-ESD stricture has not been evaluated. This study aimed to compare the degree of stricture caused by two major ESU modes (ENDO CUT mode and FORCED COAG mode) in a porcine model.

Methods

Twelve ESD procedures covering half of the circumference were performed in six pigs. Mucosal incision was performed with a ball-tip flush knife and submucosal dissection was performed with a hook knife; the two modes used were ENDO CUT I (Effect 2, Duration 2, Interval 3) and FORCED COAG mode (Effect 3, 40 W) (VIO300D, ERBE Germany). The pigs were killed humanely 30 days after ESD, and the severity of stricture and fibrosis was assessed.

Results

The resected site of the esophagus showed complete mucosal regrowth and scar formation in all pigs. There was no significant difference between the two modes in procedure time and size of resected specimen (14.4 ± 2.4 and 15.9 ± 6.1 min, P = 0.589; 626 ± 148, 661 ± 186 mm2, P = 0.74, respectively). Stricture rate and severity of fibrosis in the submucosal layer were significantly lower in ENDO CUT mode than in FORCED COAG mode (31.5 ± 16.0% vs 44.3 ± 11.6%, P = 0.046; 36.2 ± 17.1% vs 60.4 ± 26.8%, P = 0.024, respectively).

Conclusions

ENDO CUT mode showed promising ability to attenuate fibrosis and stricture after esophageal ESD.

Keywords

Endoscopic submucosal dissection Post-ESD esophageal stricture Electrosurgical unit 

Notes

Funding

This study was funded by The Osaka Foundation for The Prevention of Cancer and Life-style-related Diseases.

Compliance with ethical standards

Disclosures

Ryu Ishihara, Masamichi Arao, Yusuke Tonai, Taro Iwatsubo, Satoki Shichijyo, Noriko Matsuura, Hiroko Nakahira, Sachiko Yamamoto, Yoji Takeuchi, Koji Higashino, Noriya Uedo, and Shinichi Nakatsuka have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:359–386CrossRefGoogle Scholar
  2. 2.
    Yamashina T, Ishihara R, Nagai K, Matsuura N, Matsui F, Ito T, Fujii M, Yamamoto S, Hanaoka N, Takeuchi Y, Higashino K, Uedo N, Iishi H (2013) Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma. Am J Gastroenterol 108:544–551CrossRefPubMedGoogle Scholar
  3. 3.
    Igaki H, Kato H, Tachimori Y, Daiko H, Fukaya M, Yajima S, Nakanishi Y (2001) Clinicopathologic characteristics and survival of patients with clinical stage I squamous cell carcinomas of the thoracic esophagus treated with three-field lymph node dissection. Eur J Cardiothorac Surg 20:1089–1094CrossRefPubMedGoogle Scholar
  4. 4.
    Yamamoto S, Ishihara R, Motoori M, Kawaguchi Y, Uedo N, Takeuchi Y, Higashino K, Yano M, Nakamura S, Iishi H (2011) Comparison between definitive chemoradiotherapy and esophagectomy in patients with clinical stage I esophageal squamous cell carcinoma. Am J Gastroenterol 106:1048–1054CrossRefPubMedGoogle Scholar
  5. 5.
    Oyama T, Tomori A, Hatta K, Morita S, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:67–70CrossRefGoogle Scholar
  6. 6.
    Katada C, Muto M, Manabe T, Boku N, Ohtsu A, Yoshida S (2003) Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 57:165–169CrossRefPubMedGoogle Scholar
  7. 7.
    Hashimoto S, Kobayashi M, Takeuchi M, Sato Y, Narisawa R, Aoyagi Y (2011) The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 74:1389–1393CrossRefPubMedGoogle Scholar
  8. 8.
    Ezoe Y, Muto M, Horimatsu T, Morita S, Miyamoto S, Mochizuki S, Minashi K, Yano T, Ohtsu A, Chiba T (2011) Efficacy of preventive endoscopic balloon dilation for esophageal stricture after endoscopic resection. J Clin Gastroenterol 45:222–227CrossRefPubMedGoogle Scholar
  9. 9.
    Hanaoka N, Ishihara R, Takeuchi Y, Uedo N, Higashino K, Ohta T, Kanzaki H, Hanafusa M, Nagai K, Matsui F, Iishi H, Tatsuta M, Ito Y (2012) Intralesional steroid injection to prevent stricture after endoscopic submucosal dissection for esophageal cancer: a controlled prospective study. Endoscopy 44:1007–1011CrossRefPubMedGoogle Scholar
  10. 10.
    Grooteman KV, Wong Kee Song LM, Vleggaar FP, Siersema PD, Baron TH (2017) Non-adherence to the rule of 3 does not increase the risk of adverse events in esophageal dilation. Gastrointest Endosc 85:332–337CrossRefPubMedGoogle Scholar
  11. 11.
    Yamaguchi N, Isomoto H, Nakayama T, Hayashi T, Nishiyama H, Ohnita K, Takeshima F, Shikuwa S, Kohno S, Nakao K (2011) Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 73:1115–1121CrossRefPubMedGoogle Scholar
  12. 12.
    Iizuka T, Kikuchi D, Yamada A, Hoteya S, Kajiyama Y, Kaise M (2015) Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma. Endoscopy 47:341–344PubMedGoogle Scholar
  13. 13.
    Ohki T, Yamato M, Ota M, Takagi R, Murakami D, Kondo M, Sasaki R, Namiki H, Okano T, Yamamoto M (2012) Prevention of esophageal stricture after endoscopic submucosal dissection using tissue-engineered cell sheets. Gastroenterology 143:582–588CrossRefPubMedGoogle Scholar
  14. 14.
    Nonaka K, Miyazawa M, Ban S, Aikawa M, Akimoto N, Koyama I, Kita H (2013) Different healing process of esophageal large mucosal defects by endoscopic mucosal dissection between with and without steroid injection in an animal model. BMC Gastroenterol 13:72CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Saito Y, Tanaka T, Andoh A, Minematsu H, Hata K, Tsujikawa T, Nitta N, Murata K, Fujiyama Y (2008) Novel biodegradable stents for benign esophageal strictures following endoscopic submucosal dissection. Dig Dis Sci 53:330–333CrossRefPubMedGoogle Scholar
  16. 16.
    Rayner TE, Cowin AJ, Robertson JG, Cooter RD, Harries RC, Regester GO, Smithers GW, Goddard C, Belford DA (2000) Mitogenic whey extract stimulates wound repair activity in vitro and promotes healing of rat incisional wounds. Am J Pysiol Regul Integr Comp Physiol 278:1651–1660CrossRefGoogle Scholar
  17. 17.
    Munro MG (2012) Fundamentals of electrosurgery part I: principles of radiofrequency energy for surgery. In: Feldman LS, Fuchshuber PR, Jones DB (eds) The SAGES manual on the fundamental use of surgical energy (FUSE). Springer, New York, pp 15–60CrossRefGoogle Scholar
  18. 18.
    Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2009) Endoscopic submucosal dissection of esophageal squamous cell neopasms. Clin Gastroenterol Hepatol 4:688–694CrossRefGoogle Scholar
  19. 19.
    Matsui N, Akahoshi K, Nakamura K, Ihara E, Kita H (2012) Endoscopic submucosal dissection for removal of superficial gastrointestinal neoplasms: a technical review. World J Gastrointest Endosc 16:123–136CrossRefGoogle Scholar
  20. 20.
    Fernández-Esparrach G, Calderón A, de la Peña J, Díaz Tasende JB, Esteban JM, Gimeno-García AZ, Herreros de Tejada A, Martínez-Ares D, Nicolás-Pérez D, Nogales O, Ono A, Orive-Calzada A, Parra-Blanco A, Rodríguez Muñoz S, Sánchez Hernández E, Sánchez-Yagüe A, Vázquez-Sequeirosa E, Vila J, López Rosés L (2014) Endoscopic submucosal dissection. Endoscopy 46:361–370CrossRefPubMedGoogle Scholar
  21. 21.
    Morita Y (2014) Electrocautery for ESD: setting of the electrical surgical unit VIO300D. Gastrointest Endoscopy Clin N Am 24:183–189CrossRefGoogle Scholar
  22. 22.
    Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48:452–458CrossRefPubMedGoogle Scholar
  23. 23.
    Bahin FF, Burgess NG, Kabir S, Mahajan H, Subramanian V, Pellise M, Sonson R, Bourke MJ (2016) Comparison of the histopathological effects of two electrosurgical currents in an in vivo porcine model of esophageal endoscopic mucosal resection. Endoscopy 48:117–122CrossRefPubMedGoogle Scholar
  24. 24.
    Tonai Y, Ishihara R, Yamasaki Y, Arao M, Iwatsubo T, Kato M, Suzuki S, Hamada K, Shichijo S, Matsuura N, Kanesaka T, Nakahira H, Yamamoto S, Akasaka T, Hanaoka N, Takeuchi Y, Higashino K, Uedo N, Tomita Y, Iishi H (in press) Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model. Endosc Int OpenGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Masamichi Arao
    • 1
  • Ryu Ishihara
    • 1
    • 2
  • Yusuke Tonai
    • 2
  • Taro Iwatsubo
    • 1
  • Satoki Shichijyo
    • 1
  • Noriko Matsuura
    • 1
  • Hiroko Nakahira
    • 1
  • Sachiko Yamamoto
    • 1
  • Yoji Takeuchi
    • 1
  • Koji Higashino
    • 1
  • Noriya Uedo
    • 1
  • Shinichi Nakatsuka
    • 3
  1. 1.Division of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
  2. 2.Division of GastroenterologySanda City HospitalHyogoJapan
  3. 3.Division of Pathology and CytologyOsaka International Cancer InstituteOsakaJapan

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