Beyond the Snare: Technically Accessible Large en Bloc Colonic Resection in the West: An Animal Study

Abstract

HK-ESD with SG submucosal injection is superior to CSI-EMR for en bloc excision of 50 mm diameter lesions in a porcine model. The technique is rapidly learnt. This novel approach may lower the barrier to colonic ESD for Western endoscopists.

Pilot study of ‘Scissorhands’ technique for gastric endoscopic submucosal dissection using novel gel and endoscopic scissors in a porcine model (with video)

“…However, recent data suggest that this technique allows en bloc resection in <70% of cases (and can be as low as 20%). 8,9 In addition, other disadvantages include difficulty of carrying out ESD after failed CSI-EMR as a complete circumferential incision might hinder dissection into the submucosal layer because of the layer's inability to retain the injected submucosal fluid. Therefore, ESD is currently preferable to CSI-EMR for en bloc resection of large gastrointestinal lesions.…”

“…It requires ESD‐style submucosal incision of the perimeter of the lesion, but then uses EMR to avoid the need for dissection beneath the lesion, which is the most challenging and time‐consuming component of ESD. However, CSI‐EMR has shortcomings including suboptimal en bloc resection rates . Modifications to traditional ESD and CSI‐EMR techniques may render ESD more accessible to Western endoscopists and any methods that simplify the steps associated with ESD may disseminate its use.…”

“…7 Another option for large en bloc resection is circumferential submucosal incision EMR (CSI-EMR), a hybrid EMR and ESD technique. 8 It requires ESD-style submucosal incision of the perimeter of the lesion, but then uses EMR to avoid the need for dissection beneath the lesion, which is the most challenging and time-consuming component of ESD. However, CSI-EMR has shortcomings including suboptimal en bloc resection rates.…”

“…However, CSI-EMR has shortcomings including suboptimal en bloc resection rates. 8,9 Modifications to traditional ESD and CSI-EMR techniques may render ESD more accessible to Western endoscopists and any methods that simplify the steps associated with ESD may disseminate its use.…”

Impact of enteral nutrition on postoperative immune function and nutritional status

“…The application of EN rather than parenteral nutrition in the postoperative stages has been adopted extensively in clinical practice (Jimenez Jimenez et al, 2011;Sanchez Alvarez et al, 2011;Yi et al, 2012). It has been shown previously that early postoperative nutritional support can reduce surgical trauma-related high metabolism, maintain the functions of the intestinal mucosal barrier, and decrease the incidence of intestinal-borne infections, improving recovery of patients (Willis et al, 2008;Del Pilar Velazquez et al, 2010;Moss et al, 2012;Ong and Fock, 2012).…”