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01-06-2018

Comparison of ENDO CUT mode and FORCED COAG mode for the formation of stricture after esophageal endoscopic submucosal dissection in an in vivo porcine model

Authors: Masamichi Arao, Ryu Ishihara, Yusuke Tonai, Taro Iwatsubo, Satoki Shichijyo, Noriko Matsuura, Hiroko Nakahira, Sachiko Yamamoto, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Shinichi Nakatsuka

Published in: Surgical Endoscopy | Issue 6/2018

Abstract

Background and study aim

Stricture is a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. To date, various methods have been developed to prevent stricture. However, the mechanism by which different electrosurgical unit (ESU) modes affect the formation of post-ESD stricture has not been evaluated. This study aimed to compare the degree of stricture caused by two major ESU modes (ENDO CUT mode and FORCED COAG mode) in a porcine model.

Methods

Twelve ESD procedures covering half of the circumference were performed in six pigs. Mucosal incision was performed with a ball-tip flush knife and submucosal dissection was performed with a hook knife; the two modes used were ENDO CUT I (Effect 2, Duration 2, Interval 3) and FORCED COAG mode (Effect 3, 40 W) (VIO300D, ERBE Germany). The pigs were killed humanely 30 days after ESD, and the severity of stricture and fibrosis was assessed.

Results

The resected site of the esophagus showed complete mucosal regrowth and scar formation in all pigs. There was no significant difference between the two modes in procedure time and size of resected specimen (14.4 ± 2.4 and 15.9 ± 6.1 min, P = 0.589; 626 ± 148, 661 ± 186 mm², P = 0.74, respectively). Stricture rate and severity of fibrosis in the submucosal layer were significantly lower in ENDO CUT mode than in FORCED COAG mode (31.5 ± 16.0% vs 44.3 ± 11.6%, P = 0.046; 36.2 ± 17.1% vs 60.4 ± 26.8%, P = 0.024, respectively).

Conclusions

ENDO CUT mode showed promising ability to attenuate fibrosis and stricture after esophageal ESD.

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Title: Comparison of ENDO CUT mode and FORCED COAG mode for the formation of stricture after esophageal endoscopic submucosal dissection in an in vivo porcine model
Authors: Masamichi Arao
Ryu Ishihara
Yusuke Tonai
Taro Iwatsubo
Satoki Shichijyo
Noriko Matsuura
Hiroko Nakahira
Sachiko Yamamoto
Yoji Takeuchi
Koji Higashino
Noriya Uedo
Shinichi Nakatsuka
Publication date: 01-06-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-6000-4

At a glance: The STEP trials

Springer Medicine

Comparison of ENDO CUT mode and FORCED COAG mode for the formation of stricture after esophageal endoscopic submucosal dissection in an in vivo porcine model

Abstract

Background and study aim

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background and study aim

Methods

Results

Conclusions

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