Technical feasibility of a newly designed bendable forceps for difficult endoscopic tissue samplings (with video).

Abstract

Biopsies with conventional forceps beyond the operating range are difficult and cumbersome. Thus, we developed a new bendable forceps for improved access to gastrointestinal lesions and evaluated its technical feasibility. A bendable forceps was constructed with two channels and a two-stage knob. The bending motion-related structures were designed to improve the range of motion. For the evaluation of the forceps, we used 2 gastrointestinal simulators: an ex vivo porcine model, and an in vivo porcine model with some difficult endoscopic biopsy cases. All evaluations were performed by 5 expert endoscopists and an expert pathologist. Compared with the conventional forceps, the bendable forceps had greater efficacy in the simulator (6.2±0.4 vs. 1.96±0.2, p<0.001), ex vivo porcine model (6.33±0.52 vs. 4.25±0.89, p<0.001), and in vivo porcine model (6.33±0.52 vs. 4.25±0.89, p<0.001); greater safety in the simulator (1.92±0.13s vs. 4.88±0.50s, p<0.001), ex vivo porcine model (2.02±0.15s vs 4.66±0.27s, p<0.001), and in vivo porcine model (2.02±0.15s vs. 4.08±0.70s, p=0.002); and larger specimens in the ex vivo porcine model (3.92±0.03mm vs. 3.85±0.07mm, p=0.020). This study showed that compared with the conventional forceps, the bendable forceps was effective and safe to use for accessing difficult lesions in the three models. We believe that the bendable forceps serves as a useful supplementary diagnostic tool for accessing difficult lesions. However, further validation of its usefulness in the human body is needed.