Sa1598 Molecular Endomicroscopy for Diagnosis of Gastric Cancer: Targeting Epidermal Growth Factor Receptor (EGFR)

Abstract

dissection time (SDT) and complications with a new instrument (EndoLifter) for ESD were evaluated. Method: This is a randomized controlled live porcine study. Totally 32 (16 paired) gastric ESD were performed. Locations and sequences of ESD with or without EndoLifter were randomized by dices. The operators performed a pair of ESD at the same location of different porcine according to the result of randomization. The locations of resected targets were on the antigravity side of stomach (great curvature side of antrum to lower body). Gastroscopes with water jet (GIF-260J) and electrosurgical generator (ESG-100, Olympus Medical System, Tokyo, Japan) were used. Indigo camine (1%) and epinephrine (1mg) were added to 250 cc Glycerol as a solution for submucosal injection. First, the operators marked the margin of target lesions. After complete circumferential cutting the margin, the cap or EndoLifter was stet before submucosal dissection. Only dual knife (KD-650L) was used for submucosal dissection. Area of the resected specimens was calculated by long axis multiplied by short axis. The evaluated parameters were SDT, sessions of submucosal injection, bleeding, perforation and failure of procedure. Results: There was no significant difference between without EndoLifter and with EndoLifter groups in size of resected specimens (33.5 15.3 cm2 vs 30.0 9.5 cm2; p 0.364). With EndoLifter, the SDT was significant shorter (42.9 27.3 min vs 27.2 16.5 min; p 0.010). Sessions of submucosal injection also were significantly less in EndoLifter group (8.9 7.7 vs 2.9 3.9; p 0.005). Occurrence of bleeding was also significant lower in EndoLifter group (6.6 5.3 vs 2.8 2.0; p 0.006). In the group with EndoLifter, there was no perforation or failure. Perforation occurred in three of 16 sessions without EndoLifter. One ESD without EndoLifter failed and was rescued by use of EndoLifter. Conclusion: This study showed the efficacy and benefit of EndoLifter in gastric ESD for lesions at anti-gravity area in live porcine model. EndoLifter shortened the SDT significantly. It also showed the advantage of less sessions of submucosl injection, less bleeding and complications. These may be due to better visualization of submucosal layers with adequate traction of EndoLifter to separate mucosa and submucosa during the dissection.