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Colorectal endoscopic submucosal dissection using novel articulating devices: a comparative study in a live porcine model

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Abstract

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.

Methods

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.

Results

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).

Conclusions

Use of the new ESD method allows for reduced adverse events and a shortened resection time.

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Abbreviations

ESD:

Endoscopic submucosal dissection

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Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (http://www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Yasuharu Okamoto, Tomohiko Moriyama, Motohiro Esaki & Takanari Kitazono

  2. Center for Advanced Medical Innovation, Kyushu University, Fukuoka, Japan

    Ryu Nakadate, Tsutomu Iwasa & Makoto Hashizume

  3. Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan

    Shotaro Nakamura

  4. Department of Mechanical Engineering, Faculty of Engineering, Kyushu University, Fukuoka, Japan

    Jumpei Arata

  5. Department of Advanced Medical Initiatives, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Susumu Oguri, Kenoki Ohuchida, Tomohiko Akahoshi, Tetsuo Ikeda & Makoto Hashizume

  6. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Tsutomu Iwasa

  7. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Kenoki Ohuchida

  8. Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Makoto Hashizume

Authors
  1. Yasuharu Okamoto
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  2. Ryu Nakadate
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  3. Shotaro Nakamura
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  4. Jumpei Arata
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  5. Susumu Oguri
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  6. Tomohiko Moriyama
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  7. Motohiro Esaki
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  8. Tsutomu Iwasa
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  9. Kenoki Ohuchida
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  10. Tomohiko Akahoshi
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  11. Tetsuo Ikeda
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  12. Takanari Kitazono
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  13. Makoto Hashizume
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Contributions

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.

Corresponding author

Correspondence to Makoto Hashizume.

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Disclosures

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

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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Okamoto, Y., Nakadate, R., Nakamura, S. et al. Colorectal endoscopic submucosal dissection using novel articulating devices: a comparative study in a live porcine model. Surg Endosc 33, 651–657 (2019). https://doi.org/10.1007/s00464-018-6408-5

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  • DOI: https://doi.org/10.1007/s00464-018-6408-5

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