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Comparison of synchronous dual wavelength diode laser versus conventional endo-knives for esophageal endoscopic submucosal dissection: an animal study

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Abstract

Background

Endoscopic submucosal dissection (ESD) is widely used for en bloc resection in early gastrointestinal cancer. However, it is technically complex with long procedure time and high adverse event rates with using conventional knives. The aim of this animal study was to verify the feasibility of ESD using a novel 980/1470 nm dual diode laser (DDL-ESD) in comparison with conventional knives (C-ESD) in esophagus.

Methods

This was an in vivo animal study using eight porcine models. Four were allocated in DDL-ESD group and four were in C-ESD group. Every model underwent two ESDs to remove half circumferential esophageal mucosa. Each model’s esophagus was harvested during postmortem at 24 h after ESD. Each specimen underwent gross inspection and histopathological examination was carried out. Procedure time, completeness of en bloc resection, adverse events (bleeding and perforation) and histological injury to muscularis propria were assessed.

Results

A total of 16 ESD procedures were performed with 100% en bloc resection rate. The procedure speed in DDL-ESD group was significantly faster as compared to C-ESD group (0.27 cm2/min vs. 0.21 cm2/min, p = 0.001). The number of intraoperative bleeding points and the use of haemostatic forceps were significantly lesser in DDL-ESD group (4 ± 2 vs. 8 ± 3, p = 0.016; 1 ± 1 vs. 3 ± 2, p = 0.029). Histological assessment showed that injury to muscularis propria in DDL-ESD was milder than C-ESD. There was no perforation observed in both groups.

Conclusions

DDL-ESD technique appears to be safer and faster than C-ESD with less bleeding and injury to deep tissues.

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Acknowledgements

This work was supported by the National Nature Science Foundation of China (NO.81670604). We also thank Dr. GW Lua who is from department of Gastroenterology, Raja Perempuan 2 Hospital, Kelantan, Malaysia for editing and proofreading the manuscript.

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Author notes

  1. Jian Tang and Shufang Ye have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China

    Jian Tang, Jun Li & Feng Liu

  2. Department of Gastroenterology, Lishui people’s Hospital, Lishui, Zhejiang, China

    Shufang Ye & Xueliang Ji

  3. Digestive Endoscopy Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Mid Yanchang Road, Shanghai, 200072, China

    Feng Liu

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  1. Jian Tang
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Contributions

FL: Conception and design; JT, SY: analysis and interpretation of the data; JT, XJ: drafting of the article; JL, FL: critical revision of the article for important intellectual content; FL: study supervision. The article has been approved by all authors to be published.

Corresponding author

Correspondence to Feng Liu.

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Disclosures

Drs. Jian Tang, Shufang Ye, Xueliang Ji, Jun Li, and Feng Liu have no conflicts of interests or financial ties to disclose.

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Tang, J., Ye, S., Ji, X. et al. Comparison of synchronous dual wavelength diode laser versus conventional endo-knives for esophageal endoscopic submucosal dissection: an animal study. Surg Endosc 32, 5037–5043 (2018). https://doi.org/10.1007/s00464-018-6381-z

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  • DOI: https://doi.org/10.1007/s00464-018-6381-z

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