Dirk W Schölvinck1, Osamu Goto2, Jacques J G H M Bergman3, Naohisa Yahagi4, Bas L A M Weusten1. 1. Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands. ; Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. ; Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan. 3. Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 4. Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND/AIMS: To investigate whether the EndoLifter (Olympus), a counter-traction device facilitating submucosal dissection, can accelerate endoscopic submucosal dissection (ESD). METHODS: Two endoscopists (novice/expert in ESD) performed 64 ESDs (artificial 3-cm lesions) in 16 ex vivo pig stomachs: per stomach, two at the posterior wall (forward approach) and two at the lesser curvature (retroflex approach). Per approach, one lesion was dissected with (EL+) and one without (EL-) the EndoLifter. The submucosal dissection time (SDT), corrected for specimen size, and the influence of ESD experience on EndoLifter usefulness were assessed. RESULTS: En bloc resection rate was 98.4%. In the forward approach, the median SDT was shorter with the EndoLifter (0.56 min/cm(2) vs. 0.91 min/cm(2)), although not significantly (p=0.09). The ESD-experienced endoscopist benefitted more from the EndoLifter (0.45 [EL+] min/cm(2) vs. 0.68 [EL-] min/cm(2), p=0.07) than the ESD-inexperienced endoscopist (0.77 [EL+] min/cm(2) vs. 1.01 [EL-] min/cm(2), p=0.48). In the retroflex approach, the median SDTs were 1.06 (EL+) and 0.48 (EL-) min/cm(2) (p=0.16). The EndoLifter did not shorten the SDT for the ESD-experienced endoscopist (0.68 [EL+] min/cm(2) vs. 0.68 [EL-] min/cm(2), p=0.78), whereas the ESD-inexperienced endoscopist seemed hindered (1.65 [EL+] min/cm(2) vs. 0.38 [EL-] min/cm(2), p=0.03). CONCLUSIONS: In gastric ESD, the EndoLifter, in trend, shortens SDTs in the forward, but not in the retroflex approach. Given the low numbers in this study, a type II error cannot be excluded.
BACKGROUND/AIMS: To investigate whether the EndoLifter (Olympus), a counter-traction device facilitating submucosal dissection, can accelerate endoscopic submucosal dissection (ESD). METHODS: Two endoscopists (novice/expert in ESD) performed 64 ESDs (artificial 3-cm lesions) in 16 ex vivo pig stomachs: per stomach, two at the posterior wall (forward approach) and two at the lesser curvature (retroflex approach). Per approach, one lesion was dissected with (EL+) and one without (EL-) the EndoLifter. The submucosal dissection time (SDT), corrected for specimen size, and the influence of ESD experience on EndoLifter usefulness were assessed. RESULTS: En bloc resection rate was 98.4%. In the forward approach, the median SDT was shorter with the EndoLifter (0.56 min/cm(2) vs. 0.91 min/cm(2)), although not significantly (p=0.09). The ESD-experienced endoscopist benefitted more from the EndoLifter (0.45 [EL+] min/cm(2) vs. 0.68 [EL-] min/cm(2), p=0.07) than the ESD-inexperienced endoscopist (0.77 [EL+] min/cm(2) vs. 1.01 [EL-] min/cm(2), p=0.48). In the retroflex approach, the median SDTs were 1.06 (EL+) and 0.48 (EL-) min/cm(2) (p=0.16). The EndoLifter did not shorten the SDT for the ESD-experienced endoscopist (0.68 [EL+] min/cm(2) vs. 0.68 [EL-] min/cm(2), p=0.78), whereas the ESD-inexperienced endoscopist seemed hindered (1.65 [EL+] min/cm(2) vs. 0.38 [EL-] min/cm(2), p=0.03). CONCLUSIONS: In gastric ESD, the EndoLifter, in trend, shortens SDTs in the forward, but not in the retroflex approach. Given the low numbers in this study, a type II error cannot be excluded.
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