Abstract
BackgroundEndoscopic submucosal dissection is considered a curative and minimally invasive treatment for early gastric cancer; however, precise pathologic assessment of resected specimens is required to develop further treatment plans. Human error during specimen handling can affect objective assessment of resected specimens. In this study, we investigated whether a novel tissue fixation device offered more objective and standardized pathologic evaluation than conventional manual tissue fixation.MethodsWe developed a novel tissue fixation device for endoscopic submucosal dissection specimens. Two circular tissue samples 2, 3, and 4 cm in diameter were obtained from the body of 45 porcine stomachs. One specimen sample was placed in a fixation device; the other was manually fixed on corkboard. We used a pressure indicator to ensure constant pressure in the resected specimens in the fixation device. We measured submucosal diameter and thickness after 24 hr.ResultsThe diameters for 2, 3, and 4 cm resected tissue samples were 23.85, 32.30, and 45.0 mm and 21.0, 32.0, and 44.50 mm for the fixation device and manual pinning groups, respectively. The submucosal thicknesses in the fixation device group were 397.09, 381.43, and 415.51 μm and 393.76, 529.69, and 603.82 μm by manual pinning for 2, 3, and 4 cm tissue samples, respectively. Analysis of standard deviation revealed that the submucosal thickness in the manual fixation group was much more variable than in the fixation device group (p = 0.012, 0.042, and 0.001 for 2, 3, and 4 cm tissue specimens, respectively; Fligner-Killeen test of homogeneity of variances).ConclusionsAmong variously sized resected tissue specimens, submucosal thicknesses were more variable in the conventional fixation group, while the thicknesses were comparatively consistent in the fixation device group. After endoscopic submucosal dissection, pathologic preparation using this fixation device could offer more objective assessment of specimens.
Highlights
Endoscopic submucosal dissection (ESD) is considered a curative and minimally invasive early gastric cancer (EGC) treatment [1,2]
We investigated whether a novel tissue fixation device offered more objective and standardized pathologic evaluation than conventional manual tissue fixation
Analysis of standard deviation revealed that the submucosal thickness in the manual fixation group was much more variable than in the fixation device group (p = 0.012, 0.042, and 0.001 for 2, 3, and 4 cm tissue specimens, respectively; Fligner-Killeen test of homogeneity of variances)
Summary
Endoscopic submucosal dissection (ESD) is considered a curative and minimally invasive early gastric cancer (EGC) treatment [1,2]. ESD for EGC is a safe and curative procedure, the main variables associated with cure are the ability to perform a complete resection and lymph node metastasis [6]. The expanded criteria for curative endoscopic treatment of EGC have been determined after investigation of a large cohort presenting negligible risk of EGC lymph node metastasis based on these criteria. Endoscopic submucosal dissection is considered a curative and minimally invasive treatment for early gastric cancer; precise pathologic assessment of resected specimens is required to develop further treatment plans. We investigated whether a novel tissue fixation device offered more objective and standardized pathologic evaluation than conventional manual tissue fixation
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