Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience

Hiroaki Matsui,Toshiki Futakuchi,Naoto Tamai,Kazuki Sumiyama,Shunsuke Kamba,Akira Dobashi

doi:10.1186/s12876-021-02085-w

Hiroaki Matsui, Toshiki Futakuchi + Show 4 more

Open Access

https://doi.org/10.1186/s12876-021-02085-w

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Journal: BMC gastroenterology	Publication Date: Jan 6, 2022
Citations: 18	License type: open-access

Affiliation: Jikei University School of Medicine

Abstract

BackgroundEndoscopic submucosal dissection (ESD) is technically difficult and requires considerable training. The authors have developed a multi-loop traction device (MLTD), a new traction device that offers easy attachment and detachment. We aimed to evaluate the utility of MLTD in ESD.MethodsThis ex vivo pilot study was a prospective, block-randomized, comparative study of a porcine stomach model. Twenty-four lesions were assigned to a group that undertook ESD using the MLTD (M-ESD group) and a group that undertook conventional ESD (C-ESD group) to compare the speed of submucosal dissection. In addition, the data of consecutive 10 patients with eleven gastric lesions was collected using electronic medical records to clarify the inaugural clinical outcomes of gastric ESD using MLTD.ResultsThe median (interquartile range) speed of submucosal dissection in the M-ESD and C-ESD groups were 141.5 (60.9–177.6) mm2/min and 35.5 (20.8–52.3) mm2/min, respectively; submucosal dissection was significantly faster in the M-ESD group (p < 0.05). The rate of en bloc resection and R0 resection was 100% in both groups, and there were no perforation in either group. The MLTD attachment time was 2.5 ± 0.9 min and the MLTD extraction time was 1.0 ± 1.1 min. Clinical outcomes of MLTD in gastric ESD were almost the same as those of ex vivo pilot study.ConclusionsMLTD increased the speed of submucosal dissection in ESD and was similarly effective when used by expert and trainee endoscopists without perforation. MLTD can potentially ensure a safer and faster ESD.

Highlights

Endoscopic submucosal dissection (ESD) is technically difficult and requires considerable training
Even when the analysis was divided between expert and trainee endoscopists, submucosal dissection speed remained significantly faster in the M-ESD group (M-ESD vs. C-ESD among experts: 168.8 [150.5–280.6] vs. 48.0 [31.1–83.6] mm2/min, p < 0.05) (M-ESD vs. C-ESD among trainees: 60.2 [56.2–73.0] vs. 23.8 [20.4–42.0] mm2/min, p < 0.05)
The submucosal dissection time was significantly shorter in the M-ESD group than in the C-ESD group (7.5 [3–11.3] vs. 20.0 [10.5–27] min, p < 0.05)

Summary

Introduction

Endoscopic submucosal dissection (ESD) is technically difficult and requires considerable training. ESD is technically difficult, and requires a longer procedure time than endoscopic mucosal resection (EMR) does; mastering this technique requires extensive training [4, 5]. Various devices have been developed to improve the safety of ESD, including traction devices, which hold back the mucosa to facilitate proper visualization of the submucosa. Traction devices have been reported to improve the safety and efficacy of ESD; several difficulties when using these devices remain. The challenges associated with traction devices include the difficulty of delivering the device to the lesion site and the potential obstruction posed by the device, Matsui et al BMC Gastroenterology (2022) 22:10 because the direction of traction cannot be changed after attachment. The objective of this study was to determine the utility of MLTD in ESD using a resected porcine stomach model

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