Esophageal Endoscopic Submucosal Dissection Assisted by an Overtube with a Traction Forceps: An Animal Study

Abstract

Esophageal endoscopic submucosal dissection (ESD) is technically difficult. To make it safer, we developed a novel method using overtube with a traction forceps (OTF) for countertraction during submucosal dissection. We conducted an ex vivo animal study and compared the clinical outcomes between OTF-ESD and conventional method (C-ESD). A total of 32 esophageal ESD procedures were performed by four beginner and expert endoscopists. After circumferential mucosal incision for the target lesion, structured as the isolated pig esophagus 3 cm long, either C-ESD or OTF-ESD was randomly selected for submucosal dissection. All the ESD procedures were completed as en bloc resections, while perforation only occurred in a beginner's C-ESD procedure. The dissection time for OTF-ESD was significantly shorter than that for C-ESD for both the beginner and expert endoscopists (22.8 ± 8.3 min versus 7.8 ± 4.5 min, P < 0.001, and 11.3 ± 4.4 min versus 5.9 ± 2.5 min, P = 0.01, resp.). The frequency and volume of the submucosal injections were significantly smaller for OTF-ESD than for C-ESD (1.3 ± 0.6 times versus 2.9 ± 1.5 times, P < 0.001, and 5.3 ± 2.8 mL versus 15.6 ± 7.3 mL, P < 0.001, resp.). Histologically, muscular injury was more common among the C-ESD procedures (80% versus 13%, P = 0.009). Our results indicated that the OTF-ESD technique is useful for the safe and easy completion of esophageal ESD.

Clinical feasibility of endoscopic submucosal dissection with minimum lateral margin of superficial esophageal squamous cell carcinoma

“…The ESD procedure was performed by expert endoscopists skilled in ESD or trainees with support from expert endoscopists. Trainees were defined as those who had limited experience in performing esophageal ESD procedures (30 cases or less), and expert endoscopists had experienced performing more than 30 esophageal ESD procedures 21 .…”

Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

“…Although it has been reported that it is generally favorable to start ESD training in the gastric antrum and the rectum because of the thickness of their walls [ 51 ], the incidence of gastric cancer is not as high in Europe and the United States as in Asia [ 52 ], and it is considered difficult to obtain a chance to improve the technique. The use of pig internal organs as a training model has been reported as a method for the acquisition of techniques before endoscopic treatment in actual clinical practice [ 53 , 54 , 55 ]. While this model is useful for acquiring basic techniques, it is certainly not realistic because of the absence of factors that make ESD difficult in actual clinical practice, such as heart rate and respiratory variability.…”

Development of an animal model that reproduces pulsations for training in esophageal endoscopic submucosal dissection

“…Because the morbidity of esophageal cancer is lower than that of gastric and colon cancers [3], clinicians have limited opportunities to practice esophageal ESD, and therefore many clinicians consider this technique challenging. Studies to date have reported animal models for esophageal ESD training [4,5], but these models do not simulate the respiratory fluctuations or pulsations that make the procedure challenging in real-world practice. This report outlines our more realistic novel training model.…”