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Usefulness of the flexible traction method in gastric endoscopic submucosal dissection: an in-vivo animal study

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Abstract

Background

An appropriate traction of the target lesion is a key for a safe and secure ESD procedure. We proposed the flexible traction method (F-trac) which provided an optimal traction using an endoscopic hand-suturing (EHS) and investigated the usefulness of this technique for gastric ESD in-vivo porcine model.

Methods

In the F-trac method, a lesion was suspended by pulling proximal side of endoscope which was connected to the contralateral side with a barbed suture using the EHS technique just before starting the submucosal dissection. A single endoscopist performed conventional ESD (C-ESD) and F-trac ESD alternately for a total of ten simulating lesions of 3 cm in diameter in a live porcine stomach. The pig was rotated so that each lesion was positioned in the direction of the gravity. The procedure time, technical accuracy, adverse events, and the number of additional injection to the submucosal layer during dissection were evaluated.

Results

The total ESD procedure time in the F-trac group was significantly shorter than in C-ESD group (19.0 min vs. 30.6 min, p = 0.039). There were no significant differences between both groups in muscular layer damage, sample damage, perforation, and intraoperative bleeding. The number of additional injection in the F-trac group was significantly fewer than that in C-ESD group (0 times vs. 4.4 times, p = 0.027).

Conclusions

In gastric ESD, F-trac might be useful for shortening the total procedure time. This method can facilitate optimal traction without disturbing the endoscopic visualization and the movement of endoscope.

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Abbreviations

ESD:

Endoscopic submucosal dissection

EMR:

Endoscopic mucosal resection

EHS:

Endoscopic hand-suturing

F-trac:

Flexible traction

C-ESD:

Conventional endoscopic submucosal dissection

SD:

Standard deviation

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Acknowledgments

We thank Yuka Masuda M.D. (Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan) for helping us to create figures and a video in this article.

Funding

The study was supported by a grant-in-aid for Scientific Research (C) from the Ministry of Education, Culture, Sports, Science and Technology in Japan (Grant No. 18K07919) in 2018–2020.

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Authors and Affiliations

  1. Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Kazutoshi Higuchi, Osamu Goto, Eriko Koizumi, Kumiko Kirita, Hiroto Noda, Teppei Akimoto, Jun Omori, Mitsuru Kaise & Katsuhiko Iwakiri

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  1. Kazutoshi Higuchi
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  2. Osamu Goto
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  3. Eriko Koizumi
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  7. Jun Omori
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  9. Katsuhiko Iwakiri
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Corresponding author

Correspondence to Kazutoshi Higuchi.

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Disclosures

The flexible needle holder and the scissors forceps which were used in this study were complimentarily provided by Olympus Co. Ltd. Osamu Goto received lecture and consultant fees from Olympus Co. Ltd. Kaise Mitsuru received lecture fees from Olympus Co. Ltd. Kazutoshi Higuchi, Eriko Koizumi, Kumiko Kirita, Hiroto Noda, Teppei Akimoto, Jun Omori, and Katsuhiko Iwakiri have no conflicts of interest or financial ties to disclose.

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Video 1. The F-trac method. After circumferential mucosal incision, a proximal part of the lesion was craned with a barbed suture which is connected to the opposite side of the gastric wall by using the endoscopic hand-suturing technique. By pulling the needle side of the suture, the optimal traction is maintained during the submucosal dissection. Supplementary file1 (MP4 180792 kb)

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Higuchi, K., Goto, O., Koizumi, E. et al. Usefulness of the flexible traction method in gastric endoscopic submucosal dissection: an in-vivo animal study. Surg Endosc 34, 5632–5639 (2020). https://doi.org/10.1007/s00464-020-07850-8

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