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01-08-2019 | Dynamic Manuscript

An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video)

Authors: Akira Dobashi, Andrew C. Storm, Louis M. Wong Kee Song, Jodie L. Deters, Charles A. Miller, Crystal J. Tholen, Christopher J. Gostout, Elizabeth Rajan

Published in: Surgical Endoscopy | Issue 8/2019

Abstract

Background

Efficacy of an internal magnet traction device (MTD) for gastric endoscopic submucosal dissection (ESD) by an expert endoscopist has been reported. We hypothesized that use of the MTD would enhance the performance of colorectal ESD in a non-expert endoscopist in ESD compared to the conventional technique. Primary aim of this study was to compare procedure times between conventional ESD (C-ESD) and MTD-assisted ESD (MTD-ESD) by expert and non-expert endoscopists in ESD. Secondary aims included rate of en bloc resection, iatrogenic injury, visualization score of the submucosal layer, and endoscopist satisfaction score.

Methods

A total of 56 lesions were created in an ex vivo porcine colorectum. Two endoscopists completed C-ESD (n = 28) and MTD-ESD (n = 28). Lesions measured 3 cm in diameter and were located on either the anterior or posterior colorectal wall. The MTD consisted of a small neodymium magnet and nylon monofilament attached to a through-the-scope clip. The first MTD was deployed on the opposing colorectal wall of the target lesion and a second MTD was then deployed directly onto the distal margin of the lesion.

Results

Total procedure time for MTD-ESD was significantly shorter than C-ESD for both expert (median: 15.8 vs. 19.3 min, p < 0.05) and non-expert (median: 21.3 vs. 33.9 min, p < 0.001) endoscopists. All lesions were resected en bloc. There was no iatrogenic muscularis propria injury in the MTD-ESD group. For both the expert and non-expert, scores for MTD-ESD were significantly higher for submucosal layer visualization (p < 0.05) and endoscopist satisfaction (p < 0.001) compared to C-ESD.

Conclusions

Use of the MTD significantly reduced procedure time for both expert and non-expert endoscopists performing ESD. Improving the efficiency, safety, and satisfaction of ESD with such a device particularly for non-expert endoscopists is appealing and could potentially minimize the complexity and duration of the procedure allowing for more widespread use of the technique.

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Deprez PH, Bergman JJ, Meisner S, Ponchon T, Repici A, Dinis-Ribeiro M, Haringsma J (2010) Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy 42:853–858. https://doi.org/10.1055/s-0030-1255563 CrossRefPubMed

Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651. https://doi.org/10.1007/s00535-008-2223-4 CrossRefPubMed

Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, Yokota T (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563CrossRefPubMed

Oyama T, Kikuchi Y (2002) Aggressive endoscopic mucosal resection in the upper GI tract—Hook knife EMR method. Minim Invasive Ther Allied Technol 11:291–295. https://doi.org/10.1080/13645706.2003.11873728 CrossRefPubMed

Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T, Sekine Y, Yano T, Satoh K, Ido K, Sugano K (2003) Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35:690–694. https://doi.org/10.1055/s-2003-41516 CrossRefPubMed

Gotoda T, Oda I, Tamakawa K, Ueda H, Kobayashi T, Kakizoe T (2009) Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest Endosc 69:10–15. https://doi.org/10.1016/j.gie.2008.03.1127 CrossRefPubMed

Oyama T (2012) Counter traction makes endoscopic submucosal dissection easier. Clin Endosc 45:375–378. https://doi.org/10.5946/ce.2012.45.4.375 CrossRefPubMedPubMedCentral

Dobashi A, Storm AC, Wong Kee Song LM, Gostout CJ, Deters JL, Miller CA, Knipschield MA, Rajan E (2019) Efficacy and safety of an internal magnet traction device for endoscopic submucosal dissection: ex vivo study in a porcine model (with video). Surg Endosc 33:663–668. https://doi.org/10.1007/s00464-018-6486-4 CrossRefPubMed

Lewis JR (1993) IBM Computer usability satisfaction questionnaires—psychometric evaluation and instructions for use. Int J Hum Comput Interact 7:57–78CrossRef

10.

Jung Y, Kato M, Lee J, Gromski MA, Chuttani R, Matthes K (2013) Prospective, randomized comparison of a prototype endoscope with deflecting working channels versus a conventional double-channel endoscope for rectal endoscopic submucosal dissection in an established experimental simulation model (with video). Gastrointest Endosc 78:756–762. https://doi.org/10.1016/j.gie.2013.04.193 CrossRefPubMed

11.

Mortagy M, Mehta N, Parsi MA, Abe S, Stevens T, Vargo JJ, Saito Y, Bhatt A (2017) Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures. World J Gastroenterol 23:2883–2890. https://doi.org/10.3748/wjg.v23.i16.2883 CrossRefPubMedPubMedCentral

12.

Kondo H, Gotoda T, Ono H, Oda I, Kozu T, Fujishiro M, Saito D, Yoshida S (2004) Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer. Gastrointest Endosc 59:284–288CrossRefPubMed

13.

Storm AC, Aihara H, Skinner MJ, Thompson CC (2016) A simply placed percutaneous intragastric trocar for use of laparoscopic tools in endoscopy. Gastrointest Endosc 84:1051–1052CrossRefPubMed

14.

Imaeda H, Iwao Y, Ogata H, Ichikawa H, Mori M, Hosoe N, Masaoka T, Nakashita M, Suzuki H, Inoue N, Aiura K, Nagata H, Kumai K, Hibi T (2006) A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps. Endoscopy 38:1007–1010. https://doi.org/10.1055/s-2006-925264 CrossRefPubMed

15.

Parra-Blanco A, Nicolas D, Arnau MR, Gimeno-Garcia AZ, Rodrigo L, Quintero E (2011) Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest Endosc 74:1137–1141. https://doi.org/10.1016/j.gie.2011.07.037 CrossRefPubMed

16.

Matsumoto K, Nagahara A, Sakamoto N, Suyama M, Konuma H, Morimoto T, Sagawa E, Ueyama H, Takahashi T, Beppu K, Shibuya T, Osada T, Yoshizawa T, Ogihara T, Watanabe S (2011) A new traction device for facilitating endoscopic submucosal dissection (ESD) for early gastric cancer: the “medical ring”. Endoscopy 43(Suppl 2):E67–E68. https://doi.org/10.1055/s-0030-1255923 CrossRefPubMed

17.

Sakamoto N, Osada T, Shibuya T, Beppu K, Matsumoto K, Shimada Y, Konno A, Kurosawa A, Nagahara A, Ohkusa T, Ogihara T, Watanabe S (2008) The facilitation of a new traction device (S-O clip) assisting endoscopic submucosal dissection for superficial colorectal neoplasms. Endoscopy 40(Suppl 2):E94–E95. https://doi.org/10.1055/s-2007-995603 CrossRefPubMed

18.

Yonezawa J, Kaise M, Sumiyama K, Goda K, Arakawa H, Tajiri H (2006) A novel double-channel therapeutic endoscope (“R-scope”) facilitates endoscopic submucosal dissection of superficial gastric neoplasms. Endoscopy 38:1011–1015. https://doi.org/10.1055/s-2006-944779 CrossRefPubMed

19.

Ho KY, Phee SJ, Shabbir A, Low SC, Huynh VA, Kencana AP, Yang K, Lomanto D, So BY, Wong YY, Chung SC (2010) Endoscopic submucosal dissection of gastric lesions by using a master and slave transluminal endoscopic robot (MASTER). Gastrointest Endosc 72:593–599. https://doi.org/10.1016/j.gie.2010.04.009 CrossRefPubMed

20.

Aihara H, Ryou M, Kumar N, Ryan MB, Thompson CC (2014) A novel magnetic countertraction device for endoscopic submucosal dissection significantly reduces procedure time and minimizes technical difficulty. Endoscopy 46:422–425. https://doi.org/10.1055/s-0034-1364940 CrossRefPubMedPubMedCentral

21.

Matsuzaki I, Hattori M, Hirose K, Esaki M, Yoshikawa M, Yokoi T, Kobayashi M, Miyahara R, Hirooka Y, Goto H (2018) Magnetic anchor-guided endoscopic submucosal dissection for gastric lesions (with video). Gastrointest Endosc 87:1576–1580CrossRefPubMed

22.

Girotra M, Triadafilopoulos G, Friedland S (2018) Utility and performance characteristics of a novel submucosal injection agent (Eleview(TM)) for endoscopic mucosal resection and endoscopic submucosal dissection. Transl Gastroenterol Hepatol 3:32. https://doi.org/10.21037/tgh.2018.06.01 CrossRefPubMedPubMedCentral

23.

Wang J, Zhang XH, Ge J, Yang CM, Liu JY, Zhao SL (2014) Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis. World J Gastroenterol 20:8282–8287. https://doi.org/10.3748/wjg.v20.i25.8282 CrossRefPubMedPubMedCentral

24.

Fujiya M, Tanaka K, Dokoshi T, Tominaga M, Ueno N, Inaba Y, Ito T, Moriichi K, Kohgo Y (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81:583–595. https://doi.org/10.1016/j.gie.2014.07.034 CrossRefPubMed

Title: An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video)
Authors: Akira Dobashi
Andrew C. Storm
Louis M. Wong Kee Song
Jodie L. Deters
Charles A. Miller
Crystal J. Tholen
Christopher J. Gostout
Elizabeth Rajan
Publication date: 01-08-2019
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06817-8

At a glance: The STEP trials

Springer Medicine

An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video)

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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