Jian Tang1, Shufang Ye2, Xueliang Ji2, Jun Li1, Feng Liu3,4. 1. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China. 2. Department of Gastroenterology, Lishui people's Hospital, Lishui, Zhejiang, China. 3. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China. drliuffeng@hotmail.com. 4. Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Mid Yanchang Road, Shanghai, 200072, China. drliuffeng@hotmail.com.
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.
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.
Entities:
Keywords:
Endoscopic submucosal dissection; Equipment and supplies; Laser
Authors: H Takahashi; Y Arimura; S Okahara; S Uchida; S Ishigaki; H Tsukagoshi; Y Shinomura; M Hosokawa Journal: Endoscopy Date: 2011-01-13 Impact factor: 10.093
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