Ex vivo Comparison Study of Smart Shooter®, a New Endoscopic Device for Safe and Speedy Treatment

Abstract

Background: In many endoscopic procedures, the operative view can be compromised when manipulating the treatment device because the endoscopists must release their hand from the endoscope. We have developed a new device called the Smart Shooter® (SS) for simultaneous manipulation of the endoscope and treatment device, and evaluated the utility of the SS compared with the conventional method. Methods: The SS is a semirigid, loop-shaped channel extender that enables endoscopists to manipulate the treatment device with the thumb of the right hand while holding the endoscope with the same hand. We conducted a comparative study of gastric endoscopic submucosal dissection (ESD) and esophageal injection sclerotherapy (EIS) in a porcine model to compare the utility of the SS method with the conventional method. Results: In gastric ESD, all lesions were resected en bloc with no perforation. The mean operative time was significantly shorter with the SS method than with the conventional method (287.5 ± 155.4 vs. 403.5 ± 215.6 s, p = 0.04). In esophageal EIS, 4 paravenous injections were given with the SS method and 5 were given using the conventional method. Similarly, the mean operative time was significantly shorter with the SS method than with the conventional method (19.0 ± 7.8 vs. 23.8 ± 10.0 s, p = 0.04). Conclusion: Use of the SS enabled a shorter operative time for gastric ESD and esophageal EIS with no adverse events. The present results suggest that the SS can contribute to safe and speedy endoscopic treatment.

Usefulness of “Nelaton Attachment” for endoscopic submucosal dissection of colorectal neoplasms

“…There is another way that ESD knives can be manipulated. Kikuchi et al reported the utility of the Smart Shooter, a device that enables endoscopists to manipulate ESD knives using their right thumb while holding the endoscope with their right hand 11 12 . Use of this device, however, requires endoscopists to learn how to control the treatment device with their thumb, which they rarely have a chance to practice.…”

Feasibility of a Newly Developed Thumb Control Device for Simultaneous Manipulation of the Endoscope and Treatment Devices in Endoscopic Submucosal Dissection: A Clinical Feasibility Study

“…A previous study reported on the handling of treatment devices while keeping the endoscope in place [14] , but this technique apparently required improvement. To address this issue, we developed the Smart Shooter ® , which allows the endoscopist to manipulate endoscopic devices while continuing to operate the endoscope, and have reported its utility in ex-vivo studies [1,15] . Although the ex-vivo studies were conducted with many limitations, such as not evaluating bleeding or factors affecting manipulation of the endoscope (e.g., respiratory variations and heartbeat), the procedure time was significantly reduced with the use of the Smart Shooter ® compared with conventional methods.…”

“…In addition, although the Dual Knife was used in all cases in this study, we plan to investigate the treatment outcome of the Smart Shooter method when used concurrently with the IT knife and Hook Knife. It is also necessary to investigate its utility not only in ESD, but also in EMR, EIS, peroral endoscopic myotomy, and endoscopic retrograde cholangiopancreatography [15][16][17] .…”

Usefulness of Smart Shooter® for Colorectal Endoscopic Submucosal Dissection

“…It is a frequent experience that the layer to be dissected is identified, but the visual field is lost during manipulation of the treatment device. Smart Shooter® has been developed as a solution to these problems [8][9][10]. The objective of this study was to evaluate the usefulness of Smart Shooter® in colorectal ESD.…”