Gaining traction: pulley-ing your weight during endoscopic submucosal dissection

Yang, Dennis; Draganov, Peter V.

doi:10.1016/j.gie.2018.09.021

Cited by 9 publications

(13 citation statements)

References 23 publications

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“…Heterogeneity was assessed for the individual meta-analyses using the chi-squared test and the I 2 statistic [18]. Significant heterogeneity was defined as P < 0.05 using the Cochran Q test or I 2 > 50 %, with values > 50 % indicating substantial heterogeneity.…”

Section: Assessment Of Heterogeneitymentioning

confidence: 99%

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

et al. 2020

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Background and Aim: Hybrid endoscopic submucosal dissection (hybrid ESD) has become increasingly utilized to overcome the complexity of conventional ESD. The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of hybrid ESD for the treatment of colorectal lesions. Methods: Individualized search strategies were developed in accordance with PRISMA guidelines. Pooled proportions were calculated with rates estimated using random effects models. Measured outcomes included en-bloc, procedure-associated adverse events, recurrence, and need for surgery. Subgroup analyses were performed to compare effectiveness of traditional versus hybrid ESD. Results: Sixteen studies (n=751 patients) were included with an average lesion size of 27.96±10.55 mm. En-bloc resection rates were 81.63% [(95% CI, 72.07-88.44);I2=80.89]. Adverse events, recurrence, and need for surgery occurred in 7.74% [(95% CI, 4.78-12.31);I2=65.84], 4.52% [(95% CI, 1.40-13.65);I2=76.81], and 3.64% of cases [(95% CI, 1.76-7.37);I2=15.52]. Mean procedure duration was 48.83±22.37 min. On subgroup analyses comparing outcomes for conventional (n=1703) versus hybrid ESD (n=497), procedure duration was significantly shorter for hybrid ESD (mean difference 18.45 min; P=0.003) with lower adverse event rates (P=0.043); however, hybrid ESD was associated with lower rates of en-bloc resection (P<0.001). There was no difference in rates of recurrence or surgery (all P>0.05). Conclusion: While hybrid ESD is safe and effective for removal of colorectal lesions with a shorter procedure duration, fewer adverse events, and no difference in recurrence compared to conventional ESD, hybrid ESD was associated with a lower en-bloc resection rate.

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Section: Assessment Of Heterogeneitymentioning

confidence: 99%

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

et al. 2020

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“…ESD is fundamentally challenging because of the level of technical proficiency required to maintain visualization of the submucosal dissection plane during the procedure 6 . Loss of visualization of the dissection plane increases the risk of adverse events and leads to unfavorable resection outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic submucosal dissection (ESD) in the West has been restricted to specialized centers, 1–3 primarily given the high technical demand, longer procedure time, and potential for higher risk of adverse events 4,5 . Maintaining adequate visualization of the dissection plane during ESD is often the rate‐limiting step and is regarded as one of the most difficult aspects of the procedure 6 . Providing appropriate traction to expose the dissection field is crucial during ESD; however, accomplishing this feat often requires a deep understanding of advanced endoscopic resection principles.…”

Section: Introductionmentioning

confidence: 99%

Novel single‐operator through‐the‐scope traction device for endoscopic submucosal dissection: Outcomes of a multicenter randomized pilot ex‐vivo study in trainees with limited endoscopic submucosal dissection experience (with video)

et al. 2022

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Objectives Endoscopic submucosal dissection is a technically demanding procedure. The pilot study aimed to prospectively evaluate the efficacy and safety of a novel single‐operator through‐the‐scope dynamic traction device among trainees with limited endoscopic submucosal dissection (ESD) experience. Methods Randomized, controlled, pilot study comparing traction‐assisted ESD (T‐ESD) versus conventional ESD (C‐ESD) in an ex‐vivo porcine stomach model. Trainees were randomized to group 1 (T‐ESD followed by C‐ESD) and group 2 (C‐ESD followed by T‐ESD). Lesions were created on the gravity‐dependent area of the stomachs. The primary outcome was submucosal dissection speed. Secondary outcomes included differences in en‐bloc resection, adverse events, and workload, assessed by the National Aeronautical and Space Administration Task Load Index (NASA‐TLX). Results Five trainees performed two T‐ESD and two C‐ESD each, for a total of 20 procedures. Submucosal dissection speed was significantly faster in the T‐ESD group compared to the C‐ESD group (43.32 ± 22.61 vs. 24.19 ± 15.86 mm2/min; p = 0.042). En‐bloc resection was achieved in 60% with T‐ESD and 70% with C‐ESD (p = 1.00). The muscle injury rate was higher in the C‐ESD group (50% vs. 10%; p = 0.21) with 1 perforation reported with C‐ESD and none with T‐ESD. NASA‐TLX physical demand was lower with T‐ESD compared to C‐ESD (4.5 ± 2.17 vs. 6.9 ± 2.50; p = 0.03). Conclusion T‐ESD resulted in faster submucosal dissection and less physical demand when compared to C‐ESD, as performed by trainees in an ex‐vivo gravity‐dependent model. Future studies are needed to assess its role in human ESD cases.

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“…Maintaining adequate visualization of the dissection plane during ESD is often regarded the rate-limiting and most challenging aspect of the procedure. Providing adequate countertraction to expose the dissection field is key, and multiple techniques and novel platforms have been introduced, with promising results [67,68]. In addition, one of the challenges during colorectal ESD is the rapid dissipation of the injected fluid from the mucosal incision line.…”

Section: Endoscopic Submucosal Dissection Techniquementioning

confidence: 99%

Management of Malignant Polyps

Yang

Whiteford

2021

The ASCRS Textbook of Colon and Rectal Surgery

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Detailed polyp assessment is the first crucial step in determining the best therapeutic strategy.• Endoscopic resection of low-risk T1 colorectal cancer is an effective treatment in select patients. • En-bloc resection is crucial for adequate histopathologic assessment for curative intent. • Transanal endoscopic surgery is another technique that permits full-thickness en-bloc resection for select malignant polyps or early cancers in the rectum. • All polyps with predictors of deep submucosal invasion should be referred for surgery given the high risk for lymph node metastasis.

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Gaining traction: pulley-ing your weight during endoscopic submucosal dissection

Cited by 9 publications

References 23 publications

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

Novel single‐operator through‐the‐scope traction device for endoscopic submucosal dissection: Outcomes of a multicenter randomized pilot ex‐vivo study in trainees with limited endoscopic submucosal dissection experience (with video)

Management of Malignant Polyps

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