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01-11-2013

Endoscopic submucosal dissection using a carbon dioxide laser with submucosally injected laser absorber solution (porcine model)

Authors: Daisuke Obata, Yoshinori Morita, Rinna Kawaguchi, Katsunori Ishii, Hisanao Hazama, Kunio Awazu, Hiromu Kutsumi, Takeshi Azuma

Published in: Surgical Endoscopy | Issue 11/2013

Abstract

Background

Recently, endoscopic submucosal dissection (ESD) has been performed to treat early gastric cancer. The en bloc resection rate of ESD has been reported to be higher than that of conventional endoscopic mucosal resection (EMR), and ESD can resect larger lesions than EMR. However, ESD displays a higher complication rate than conventional EMR. Therefore, the development of devices that would increase the safety of ESD is desired. Lasers have been extensively studied as a possible alternative to electrosurgical tools. However, laser by itself easily resulted in perforation upon irradiation of the gastrointestinal tract. We hypothesized that performing ESD using a CO₂ laser with a submucosal laser absorber could be a safe and simple treatment for early gastric cancer. To provide proof of concept regarding the feasibility of ESD using a CO₂ laser with submucosally injected laser absorber solution, an experimental study in ex vivo and in vivo porcine models was performed.

Methods

Five endoscopic experimental procedures using a carbon dioxide (CO₂) laser were performed in a resected porcine stomach. In addition, three endoscopic experimental procedures using a CO₂ laser were performed in living pigs.

Results

In the ex vivo study, en bloc resections were all achieved without perforation and muscular damage. In addition, histological evaluations could be performed in all of the resected specimens. In the in vivo study, en bloc resections were achieved without perforation and muscular damage, and uncontrollable hemorrhage did not occur during the procedures.

Conclusions

Endoscopic submucosal dissection using a CO₂ laser with a submucosal laser absorber is a feasible and safe method for the treatment of early gastric cancer.

Soetikno R, Gotoda T, Nakanishi Y, Soehendra N (2003) Endoscopic mucosal resection. Gastrointest Endosc 57:567PubMedCrossRef

Korenaga D, Haraguchi M, Tsujitani S, Okamura T, Tamada R, Sugimachi K (1986) Clinicopathological features of mucosal carcinoma of the stomach with lymph node metastasis in eleven patients. Br J Surg 73:431–433PubMedCrossRef

Tanabe S, Koizumi W, Mitomi H, Nakai H, Murakami S, Nagaba S, Kida M, Oida M, Saigenji K (2002) Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer. Gastrointest Endosc 56:708–713PubMedCrossRef

Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225PubMedCrossRef

Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226PubMedCrossRef

Fujishiro M (2006) Endoscopic submucosal dissection for stomach neoplasms. World J Gastroenterol 12:5108PubMed

Hirao M, Masuda K, Asanuma T, Naka H, Noda K, Matsuura K, Yamaguchi O, Ueda N (1988) Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc 34:264–269PubMedCrossRef

Toyonaga T, Nishino E, Hirooka T, Dozaiku T, Sugiyama T, Iwata Y, Ono W, Ueda C, Tomita M (2005) Use of short needle knife for esophageal endoscopic submucosal dissection. Dig Endosc 17:246–252CrossRef

Oyama T, Kikuchi Y (2002) Aggressive endoscopic mucosal resection in the upper GI tract-hook knife EMR method. Minim Invasive Ther Allied Technol 11:291–296

10.

Strauss R, Fallon S (2004) Lasers in contemporary oral and maxillofacial surgery. Dent Clin N Am 48:861PubMedCrossRef

11.

Patel C (1964) Selective excitation through vibrational energy transfer and optical maser action in N₂–CO₂. Phys Rev Lett 13:617–619CrossRef

12.

Strong M, Jako G (1972) Laser surgery in the larynx. Early clinical experience with continuous CO₂ laser. Ann Otol Rhinol Laryngol 81:791PubMed

13.

Anderson R, Parrish J (1983) Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 220:524PubMedCrossRef

14.

Brugmans M, Kemper J, Gijsbers G, van der Meulen F, van Gemert M (1991) Temperature response of biological materials to pulsed non-ablative CO₂ laser irradiation. Lasers Surg Med 11:587–594PubMedCrossRef

15.

Burke L, Rovin R, Cerullo L, Brown J (1985) Thermal effects of the Nd:YAG and carbon dioxide lasers on the central nervous system. Lasers Surg Med 5:67–71PubMedCrossRef

16.

Kotlow LA (2004) Lasers in pediatric dentistry. Dent Clin N Am 48:889–922CrossRef

17.

LeCarpentier G, Motamedi M, McMath L, Rastegar S, Welch A (1993) Continuous wave laser ablation of tissue: analysis of thermal and mechanical events. IEEE Trans Biomed Eng 40:188–200PubMedCrossRef

18.

Shi Y, Wang Y, Abe Y, Matsuura Y, Miyagi M, Sato S, Taniwaki M, Uyama H (1998) Cyclic olefin polymer-coated silver hollow glass waveguides for the infrared. Appl Opt 37:7758–7762PubMedCrossRef

19.

Anandasabapathy S, Maru D, Klumpp S, Uthamanthil R, Borne A, Bhutani M (2009) Novel endoscopic application of a new flexible-fiber CO₂ laser for esophageal mucosal ablation in a porcine model. Endoscopy 41:138–142PubMedCrossRef

20.

Hayashi T, Arai T, Tajiri H, Niwa H (1997) Enhanced diode laser ablation using submucosal injection of indocyanine green solution: part II; irradiation to resected porcine gastric wall and canine gastric walls under laparotomy. Gastroenterol Endosc 39:1753–1765

21.

Kawaguchi A, Nagao S, Takebayashi K, Higashiyama M, Komoto S, Hokari R, Miura S (2008) Long-term outcome of endoscopic semiconductive diode laser irradiation therapy with injection of indocyanine green for early gastric cancer. J Gastroenterol Hepatol 23:1193–1199PubMedCrossRef

Title: Endoscopic submucosal dissection using a carbon dioxide laser with submucosally injected laser absorber solution (porcine model)
Authors: Daisuke Obata
Yoshinori Morita
Rinna Kawaguchi
Katsunori Ishii
Hisanao Hazama
Kunio Awazu
Hiromu Kutsumi
Takeshi Azuma
Publication date: 01-11-2013
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-3029-x

At a glance: The STEP trials

Springer Medicine

Endoscopic submucosal dissection using a carbon dioxide laser with submucosally injected laser absorber solution (porcine model)

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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