Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video)

Parra‐Blanco, Adolfo; Nicolás, David; Arnau, María Rosa; García, Antonio Z. Gimeno; Rodrigo, Luís; Quintero, Enrique

doi:10.1016/j.gie.2011.07.037

Cited by 64 publications

(44 citation statements)

References 22 publications

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“…The first author has performed near 200 ESDs in pig model, and has performed around 40 human ESDs in the stomach, rectum and colon, some of them supervised by Japanese experts. We also proved the feasibility of a simple traction method (the clip-band method) for gastric ESD in a porcine model,33 which we have later on applied in human ESD successfully in 15 cases (unpublished results). The second author (N. Gonzalez) collaborated as an assistant in the animal ESD training program of the first author, then performed 30 gastric ESDs in an ex vivo model (Figs.…”

Section: Personal Experience In Animal Models For Training In Esdmentioning

confidence: 69%

Ex VivoandIn VivoModels for Endoscopic Submucosal Dissection Training

2012

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Endoscopic submucosal dissection is a technically challenging but highly effective technique for the treatment of well selected early neoplasms in the digestive tract. Although it is frequently performed in East Asian countries, the Western world has not adopted this technique yet, probably due in part to the difficulty to learn it. Ex vivo and in vivo animal models are invaluable tools to overcome at least the beginning of the learning curve, although the initial step is the acquisition of basic knowledge about early diagnosis of neoplasias, and observing real procedures in expert centers. The practical issues, advantages, and disadvantages of the ex vivo and in vivo models are discussed.

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Section: Personal Experience In Animal Models For Training In Esdmentioning

confidence: 69%

Ex VivoandIn VivoModels for Endoscopic Submucosal Dissection Training

2012

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“…However, the operative field yielded by this transparent hood is still limited by its diameter and length and theoretically requires substantial experience. The efficacy of novel devices that provide endoscopists with countertraction and direct visualization of the dissection line have been investigated, including the sinker device 10 ; external grasping forceps 11–13 ; thin endoscope 14,15 ; and internal traction using nylon suture, 16 a spring, 17 and a rubber band 18,19 ; percutaneous traction 20 ; and peroral traction 21 with a pulley method. 2,22 In addition, injectable reverse-phase polymer has been suggested to assist in ESD by providing mechanical force in transitioning from a liquid to a more solid substance.…”

Section: Discussionmentioning

confidence: 99%

“…The suture-pulley method has several advantages over the other traction devices. First, compared with the internal traction methods (the sinker device, 10 internal traction using nylon suture, 16 a spring, 17 and a rubber band, 18,19 the assistant can maintain and precisely adjust the tension force in accordance with ESD progression simply by pulling the suture tail. Second, compared with the external traction methods using assistive endoscopic devices (external grasping forceps 11–13 and an additional thin endoscope 14,15 ), the working space of therapeutic endoscope is not restricted by the traction device.…”

Section: Discussionmentioning

confidence: 99%

Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video)

Aihara

Kumar

Ryou

et al. 2014

Gastrointestinal Endoscopy

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Background The lack of countertraction in endoscopic submucosal dissection (ESD) results in increased technical demand and procedure time. Although the suture-pulley method for countertraction has been reported, its effectiveness compared with the traditional ESD technique remains unclear. Objective To objectively analyze efficacy of countertraction using the suture-pulley method for ESD. Design Prospective ex vivo animal study. Setting Animal laboratory. Interventions Twenty simulated gastric lesions were created in porcine stomachs by using a standard circular template 30 mm in diameter. In the control arm (n = 10), ESD was performed by using the standard technique. In the suture-pulley arm (N = 10), a circumferential incision was made, and an endoscopic suturing device was used to place the suture pulley. Main Outcome Measurements The primary outcome of this study was total procedure time. Results The median total procedure time with the suture-pulley method was significantly shorter than the traditional ESD technique (median, 25% to 75%, interquartile range [IQR]: 531 seconds [474.3–549.3 seconds] vs 845 seconds [656.3–1547.5 seconds], P < .001). The median time (IQR) for suture-pulley placement was 160.5 seconds (150.0–168.8 seconds). Although there was a significantly longer procedure time for proximal versus middle/lower stomach lesions with traditional ESD (median, 1601 seconds; IQR, 1547.5–1708.8 seconds vs median, 663 seconds; IQR, 627.5–681.8 seconds; P =.01), there was no significant difference in procedure time for lesions of various locations when using the suture-pulley method. Compared with traditional ESD, the suture-pulley method was less demanding in all categories evaluated by the NASA Task Load Index. Limitations Ex vivo study. Conclusions The suture-pulley method facilitates direct visualization of the submucosal layer during ESD and significantly reduces procedure time and technical difficulty. In addition, the benefit of the suture-pulley method was seen for both simple and more complicated ESDs.

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“…At present, training or developing new endoscopic techniques relies mainly on the live pig model, which has a stomach comparable in size and structure to the human stomach, to achieve a competent level 11. Furthermore, the live pig model simulates a more realistic endoscopy setting and provides the opportunity to deal with bleeding and perforations.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Using Simulated Targets in the Stomachs of Live Pigs for Full Endoscopic Submucosal Dissection Training

Wang¹,

Shih²,

Hung³

et al. 2014

Gut Liver

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Background/AimsIn endoscopic submucosal dissection (ESD) training, only a flat target lesion can usually be simulated in the normal mucosa. This study aimed to evaluate the feasibility of simulated targets in the stomachs of live pigs for complete training.MethodsSix trained endoscopists with hands-on experience with ex vivo, isolated pig stomachs were enrolled in this pilot study. An endoscopic banding device was used to create a polyp that was snared, leaving an ulcerated lesion. This simulated target model was used to perform ESD in pigs. The en bloc resection rate, procedure time, complications, quality of resection, and participants’ opinions on the simulated targets were compared with the conventional model.ResultsEn bloc resections were achieved in all six simulated targets and six conventional models. The mean size of the resected specimens was 32.2 mm (range, 20 to 39 mm) in the simulated target group and 23.5 mm (range, 11 to 40 mm) in the conventional group. The target model had a high quality of resection and had a high satisfaction rate for margin identification and correct peripheral marking.ConclusionsGood identification of the lesion and ease of periphery marking in the target model may improve resection quality.

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Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video)

Cited by 64 publications

References 22 publications

Ex VivoandIn VivoModels for Endoscopic Submucosal Dissection Training

Ex VivoandIn VivoModels for Endoscopic Submucosal Dissection Training

Facilitating endoscopic submucosal dissection: the suture-pulley method significantly improves procedure time and minimizes technical difficulty compared with conventional technique: an ex vivo study (with video)

The Feasibility of Using Simulated Targets in the Stomachs of Live Pigs for Full Endoscopic Submucosal Dissection Training

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