Endoscopic submucosal dissection by using a flexible Maryland dissector: a randomized, controlled, porcine study (with videos)

Abstract

Endoscopic submucosal dissection (ESD) is a minimally invasive method for en bloc removal of GI lesions. Current ESD methods and devices have limitations, including long procedure times, technical difficulty, safety, and availability. The aim of this study was to evaluate a blunt submucosal dissection technique and compare it with ESD by using the insulated-tip (IT) knife. Randomized, controlled, animal study. Animal facility laboratory. Twelve gastric lesions were marked by using electrocautery. After submucosal injection, a circumferential mucosal incision was created. ESD was then performed by using either the IT knife 2 (n = 6) or the flexible endoscopic Maryland dissector (n = 6). Median time for IT knife ESD versus median time for Maryland dissector ESD. Median time (IQR) for IT knife ESD was 43 minutes (range 36-50 minutes). The median time (IQR) for Maryland dissector ESD was 32 minutes (range 22-41 minutes; P = .09). The resection specimens obtained with the Maryland dissector tended to be larger, with a median (IQR) of 20.2 cm(2) (range 16.4-23 cm(2)) when compared with specimens resected with the IT knife, which yielded a median (IQR) resection area of 15.9 cm(2) (14.8-18.7 cm(2); P = .08). Complete en-bloc resection including all of the electrocautery markings was achieved in all cases. There were no perforations. There were two minor hemorrhages in the IT knife group and 3 in the Maryland dissector group. Nonsurvival setting, small sample size. The flexible Maryland dissector was demonstrated to be efficient, safe, and feasible for facilitating gastric ESD in a live animal model.