BACKGROUND: The lack of countertraction in endoscopic submucosal dissection (ESD) results in increased technical demand and procedure time. Although the suture-pulley method for countertraction has been reported, its effectiveness compared with the traditional ESD technique remains unclear. OBJECTIVE: To objectively analyze efficacy of countertraction using the suture-pulley method for ESD. DESIGN: Prospective ex vivo animal study. SETTING: Animal laboratory. INTERVENTIONS: Twenty simulated gastric lesions were created in porcine stomachs by using a standard circular template 30 mm in diameter. In the control arm (n = 10), ESD was performed by using the standard technique. In the suture-pulley arm (N = 10), a circumferential incision was made, and an endoscopic suturing device was used to place the suture pulley. MAIN OUTCOME MEASUREMENTS: The primary outcome of this study was total procedure time. RESULTS: The median total procedure time with the suture-pulley method was significantly shorter than the traditional ESD technique (median, 25% to 75%, interquartile range [IQR]: 531 seconds [474.3-549.3 seconds] vs 845 seconds [656.3-1547.5 seconds], P < .001). The median time (IQR) for suture-pulley placement was 160.5 seconds (150.0-168.8 seconds). Although there was a significantly longer procedure time for proximal versus middle/lower stomach lesions with traditional ESD (median, 1601 seconds; IQR, 1547.5-1708.8 seconds vs median, 663 seconds; IQR, 627.5-681.8 seconds; P = .01), there was no significant difference in procedure time for lesions of various locations when using the suture-pulley method. Compared with traditional ESD, the suture-pulley method was less demanding in all categories evaluated by the NASA Task Load Index. LIMITATIONS: Ex vivo study. CONCLUSIONS: The suture-pulley method facilitates direct visualization of the submucosal layer during ESD and significantly reduces procedure time and technical difficulty. In addition, the benefit of the suture-pulley method was seen for both simple and more complicated ESDs.
BACKGROUND: The lack of countertraction in endoscopic submucosal dissection (ESD) results in increased technical demand and procedure time. Although the suture-pulley method for countertraction has been reported, its effectiveness compared with the traditional ESD technique remains unclear. OBJECTIVE: To objectively analyze efficacy of countertraction using the suture-pulley method for ESD. DESIGN: Prospective ex vivo animal study. SETTING: Animal laboratory. INTERVENTIONS: Twenty simulated gastric lesions were created in porcine stomachs by using a standard circular template 30 mm in diameter. In the control arm (n = 10), ESD was performed by using the standard technique. In the suture-pulley arm (N = 10), a circumferential incision was made, and an endoscopic suturing device was used to place the suture pulley. MAIN OUTCOME MEASUREMENTS: The primary outcome of this study was total procedure time. RESULTS: The median total procedure time with the suture-pulley method was significantly shorter than the traditional ESD technique (median, 25% to 75%, interquartile range [IQR]: 531 seconds [474.3-549.3 seconds] vs 845 seconds [656.3-1547.5 seconds], P < .001). The median time (IQR) for suture-pulley placement was 160.5 seconds (150.0-168.8 seconds). Although there was a significantly longer procedure time for proximal versus middle/lower stomach lesions with traditional ESD (median, 1601 seconds; IQR, 1547.5-1708.8 seconds vs median, 663 seconds; IQR, 627.5-681.8 seconds; P = .01), there was no significant difference in procedure time for lesions of various locations when using the suture-pulley method. Compared with traditional ESD, the suture-pulley method was less demanding in all categories evaluated by the NASA Task Load Index. LIMITATIONS: Ex vivo study. CONCLUSIONS: The suture-pulley method facilitates direct visualization of the submucosal layer during ESD and significantly reduces procedure time and technical difficulty. In addition, the benefit of the suture-pulley method was seen for both simple and more complicated ESDs.
Authors: K Matsumoto; A Nagahara; N Sakamoto; M Suyama; H Konuma; T Morimoto; E Sagawa; H Ueyama; T Takahashi; K Beppu; T Shibuya; T Osada; T Yoshizawa; T Ogihara; S Watanabe Journal: Endoscopy Date: 2011-02-21 Impact factor: 10.093
Authors: J Y Ahn; K D Choi; J Y Choi; M-Y Kim; J H Lee; K-S Choi; D H Kim; H J Song; G H Lee; H-Y Jung; J-H Kim Journal: Endoscopy Date: 2010-12-16 Impact factor: 10.093
Authors: H Imaeda; Y Iwao; H Ogata; H Ichikawa; M Mori; N Hosoe; T Masaoka; M Nakashita; H Suzuki; N Inoue; K Aiura; H Nagata; K Kumai; T Hibi Journal: Endoscopy Date: 2006-04-27 Impact factor: 10.093
Authors: Stefan von Delius; Artemisia Karagianni; Claus Hann von Weyhern; Hubertus Feussner; Tibor Schuster; Roland M Schmid; Eckart Frimberger Journal: Gastrointest Endosc Date: 2008-06-17 Impact factor: 9.427
Authors: Richard F Knoop; Edris Wedi; Golo Petzold; Sebastian C B Bremer; Ahmad Amanzada; Volker Ellenrieder; Albrecht Neesse; Steffen Kunsch Journal: Surg Endosc Date: 2020-07-16 Impact factor: 4.584