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Endoscopic Submucosal Dissection Using a Novel Versatile Knife: An Animal Feasibility Study (with Video).

Kwon CI, Kim G, Chung IK, Kim WH, Ko KH, Hong SP, Jeong S, Lee DH - Clin Endosc (2014)

Bottom Line: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives).The rate of adverse events and histological quality did not statistically differ between the modalities.ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

View Article: PubMed Central - PubMed

Affiliation: Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

ABSTRACT

Background/aims: In order to reduce the procedure time and the number of accessory changes during endoscopic submucosal dissection (ESD), we developed a novel versatile knife, which has the combined advantages of several conventional knives. The aim of this study was to compare the efficacy, safety, and histological quality of ESD performed using this novel versatile knife and a combination of several conventional knives.

Methods: This was an in vivo animal study comparing two different modalities of ESD in mini-pigs. Completion time of each resection was documented, and the resected specimens were retrieved and evaluated for completeness. To assess the quality control of the procedures and adverse events, detailed histopathological examinations were performed.

Results: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives). All resections were completed as en bloc resections. There was no significant difference in procedure time between the 2 modalities (456 seconds vs. 355 seconds, p=0.258) and cutting speed (1.983 mm(2)/sec vs. 1.57 mm(2)/sec, p=1.000). The rate of adverse events and histological quality did not statistically differ between the modalities.

Conclusions: ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

No MeSH data available.


Representative histological findings of endoscopic mucosal dissection (ESD) specimens and residual muscularis propria tissue from the Optimos knife group (A-D) and combination knives group (E-H; H&E stain). (A, B) ESD showing minimal injury to the lamina propria and submucosa in the Optimos knife group. (C, D) Residual bed tissue showing minimal injury to the lamina propria and muscularis propria in the Optimos knife group. (E, F) ESD showing minimal injury to the lamina propria and submucosa in the combination knives group. (G, H) Residual bed tissue showing marked injury in the lamina propria and muscularis propria in the combination knives group. Arrows represent the extent of injury. Scale bars represent 50 µm in (B) and (F) and 500 µm in the others.
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Figure 5: Representative histological findings of endoscopic mucosal dissection (ESD) specimens and residual muscularis propria tissue from the Optimos knife group (A-D) and combination knives group (E-H; H&E stain). (A, B) ESD showing minimal injury to the lamina propria and submucosa in the Optimos knife group. (C, D) Residual bed tissue showing minimal injury to the lamina propria and muscularis propria in the Optimos knife group. (E, F) ESD showing minimal injury to the lamina propria and submucosa in the combination knives group. (G, H) Residual bed tissue showing marked injury in the lamina propria and muscularis propria in the combination knives group. Arrows represent the extent of injury. Scale bars represent 50 µm in (B) and (F) and 500 µm in the others.

Mentions: The extent and depth of tissue injury are summarized in Table 3. The injury to the lamina propria was minimal in all resected specimens. Because the largest extent of injury was only 26 µm (10 to 26 µm; median, 15), the injury did not affect the interpretation of gastric mucosal histology (Fig. 5A, E). The injury to the lamina propria in the remaining gastric bed tissue was more extensive (2 to 7.3 mm; median, 3.5) than that in the resected specimen because the stomach was harvested 18 hours after the procedures (Fig. 5B, F). The difference of lamina propria injury both in the ESD specimen and the remaining bed tissue was not significant between the two groups (p=0.800 and p=0.720, respectively) (Fig. 6A, B). The extent of injury to the submucosa in the resected specimens ranged from 56 to 668 µm (median, 239.5), whereas the injury did not affect the quality of the lamina propria (Fig. 5C, G). There was no significant difference between the two modalities (p=0.483) (Fig. 6C). The incidence of injury to the MP ranged from 0% to 20.1% (median, 8.4) compared to that in the entire normal muscular layer (Fig. 5D, H). No significant difference in the incidence of injury to the MP was found between modalities (p=0.166) (Fig. 6D).


Endoscopic Submucosal Dissection Using a Novel Versatile Knife: An Animal Feasibility Study (with Video).

Kwon CI, Kim G, Chung IK, Kim WH, Ko KH, Hong SP, Jeong S, Lee DH - Clin Endosc (2014)

Representative histological findings of endoscopic mucosal dissection (ESD) specimens and residual muscularis propria tissue from the Optimos knife group (A-D) and combination knives group (E-H; H&E stain). (A, B) ESD showing minimal injury to the lamina propria and submucosa in the Optimos knife group. (C, D) Residual bed tissue showing minimal injury to the lamina propria and muscularis propria in the Optimos knife group. (E, F) ESD showing minimal injury to the lamina propria and submucosa in the combination knives group. (G, H) Residual bed tissue showing marked injury in the lamina propria and muscularis propria in the combination knives group. Arrows represent the extent of injury. Scale bars represent 50 µm in (B) and (F) and 500 µm in the others.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260103&req=5

Figure 5: Representative histological findings of endoscopic mucosal dissection (ESD) specimens and residual muscularis propria tissue from the Optimos knife group (A-D) and combination knives group (E-H; H&E stain). (A, B) ESD showing minimal injury to the lamina propria and submucosa in the Optimos knife group. (C, D) Residual bed tissue showing minimal injury to the lamina propria and muscularis propria in the Optimos knife group. (E, F) ESD showing minimal injury to the lamina propria and submucosa in the combination knives group. (G, H) Residual bed tissue showing marked injury in the lamina propria and muscularis propria in the combination knives group. Arrows represent the extent of injury. Scale bars represent 50 µm in (B) and (F) and 500 µm in the others.
Mentions: The extent and depth of tissue injury are summarized in Table 3. The injury to the lamina propria was minimal in all resected specimens. Because the largest extent of injury was only 26 µm (10 to 26 µm; median, 15), the injury did not affect the interpretation of gastric mucosal histology (Fig. 5A, E). The injury to the lamina propria in the remaining gastric bed tissue was more extensive (2 to 7.3 mm; median, 3.5) than that in the resected specimen because the stomach was harvested 18 hours after the procedures (Fig. 5B, F). The difference of lamina propria injury both in the ESD specimen and the remaining bed tissue was not significant between the two groups (p=0.800 and p=0.720, respectively) (Fig. 6A, B). The extent of injury to the submucosa in the resected specimens ranged from 56 to 668 µm (median, 239.5), whereas the injury did not affect the quality of the lamina propria (Fig. 5C, G). There was no significant difference between the two modalities (p=0.483) (Fig. 6C). The incidence of injury to the MP ranged from 0% to 20.1% (median, 8.4) compared to that in the entire normal muscular layer (Fig. 5D, H). No significant difference in the incidence of injury to the MP was found between modalities (p=0.166) (Fig. 6D).

Bottom Line: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives).The rate of adverse events and histological quality did not statistically differ between the modalities.ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

View Article: PubMed Central - PubMed

Affiliation: Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

ABSTRACT

Background/aims: In order to reduce the procedure time and the number of accessory changes during endoscopic submucosal dissection (ESD), we developed a novel versatile knife, which has the combined advantages of several conventional knives. The aim of this study was to compare the efficacy, safety, and histological quality of ESD performed using this novel versatile knife and a combination of several conventional knives.

Methods: This was an in vivo animal study comparing two different modalities of ESD in mini-pigs. Completion time of each resection was documented, and the resected specimens were retrieved and evaluated for completeness. To assess the quality control of the procedures and adverse events, detailed histopathological examinations were performed.

Results: A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives). All resections were completed as en bloc resections. There was no significant difference in procedure time between the 2 modalities (456 seconds vs. 355 seconds, p=0.258) and cutting speed (1.983 mm(2)/sec vs. 1.57 mm(2)/sec, p=1.000). The rate of adverse events and histological quality did not statistically differ between the modalities.

Conclusions: ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.

No MeSH data available.