Safety and efficacy of a novel powered endoscopic debridement tissue resection device for management of difficult colon and foregut lesions: first multicenter U.S. experience

Kaul, Vivek; Diehl, David L.; Enslin, Sarah; Infantolino, Anthony; Tofani, Christina; Bittner, Krystle; Tariq, Raseen; Aslam, Rida; Ayub, Kamran

doi:10.1016/j.gie.2020.06.068

Cited by 15 publications

(17 citation statements)

References 11 publications

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“…In addition, snares often cut through the soft necrotic tissue rather than capturing it. Therefore, other systems for necrosectomy have been tested recently, such as the EndoRotor TM (Interscope Inc., Northbridge, Massachusetts, United States), a technically complex device originally developed for polypectomy and available only in a few centers[ 6 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience

Brand¹,

Bachmann²,

Schlag³

et al. 2022

WJGS

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BACKGROUND Endoscopic treatment of pancreatic necrosis can be challenging and time-consuming because sticky necrotic debris is sometimes difficult to remove. The over-the-scope-grasper, a new tool that has recently become available for this purpose, might also be useful for other indications. However, clinical data on the efficacy and safety of this new device are lacking. AIM To evaluate the technical success and safety of the device in a multicenter setting. METHODS The over-the-scope-grasper was used in nine selected endoscopic centers between November 2020 and October 2021 for appropriate indications. Overall, 56 procedures were included in the study. We retrospectively evaluated procedural parameters of all endoscopic interventions using a predefined questionnaire, with special respect to technical success, indications, duration of intervention, type of sedation, and complications. In the case of pancreatic necrosectomy, the access route, stent type, number of necrosis pieces removed, and clinical handling were also recorded. RESULTS A total of 56 procedures were performed, with an overall technical success rate of 98%. Most of the procedures were endoscopic pancreatic necrosectomies (33 transgastric, 4 transduodenal). In 70% of the procedures, access to the necrotic cavity was established with a lumen apposing metal stent. The technical success of pancreatic necrosectomy was 97%, with a mean of 8 pieces (range, 2-25 pieces) of necrosis removed in a mean procedure time of 59 min (range, 15-120 min). In addition, the device has been used to remove blood clots ( n = 6), to clear insufficiency cavities before endoluminal vacuum therapy ( n = 5), and to remove foreign bodies from the upper gastrointestinal tract ( n = 8). In these cases, the technical success rate was 100%. No moderate or severe/fatal complications were reported in any of the 56 procedures. CONCLUSION These first multicenter data demonstrate that the over-the-scope-grasper is a promising device for endoscopic pancreatic necrosectomy, which is also appropriate for removing foreign bodies and blood clots, or cleaning insufficiency cavities prior to endoluminal vacuum therapy.

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Section: Discussionmentioning

confidence: 99%

Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience

Brand¹,

Bachmann²,

Schlag³

et al. 2022

WJGS

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

The Over the Scope Grasper – A New Tool for Pancreatic Necrosectomy and Beyond – First Multicenter Experience

et al. 2022

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“…In a pilot study of 19 rectosigmoid polyps, technical success was 52.6% after 1 attempt and increased to 84.1% after 2 attempts (30). Although a recent retrospective analysis of 28 colorectal lesions has shown more promising results (17), further evaluation of this new technology should be within the confines of a well-designed research study.…”

Section: Discussionmentioning

confidence: 99%

Previously Attempted Large Nonpedunculated Colorectal Polyps Are Effectively Managed by Endoscopic Mucosal Resection

et al. 2021

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INTRODUCTION: Endoscopic mucosal resection (EMR) is an effective therapy for naive large nonpedunculated colorectal polyps (N-LNPCPs). The best approach for the treatment of previously attempted LNPCPs (PA-LNPCPs) is undetermined. METHODS: EMR performance for PA-LNPCPs was evaluated in a prospective observational cohort of LNPCPs ≥20 mm. Efficacy was measured by technical success (removal of all visible polypoid tissue during index EMR) and recurrence at first surveillance colonoscopy (SC1). Safety was assessed by clinically significant intraprocedural bleeding, deep mural injury types III–V, clinically significant post-EMR bleeding, and delayed perforation. RESULTS: From January 2012 to October 2019, 158 PA-LNPCPs and 1,134 N-LNPCPs underwent EMR. Median PA-LNPCP size was 30 mm (interquartile range 25–46 mm). Technical success was 93.0% and increased to 95.6% after adjusting for 2-stage EMR. Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) was required for nonlifting polypoid tissue in 73 (46.2%). Median time to SC1 was 6 months (interquartile range 5–7 months). Recurrence occurred in 9 (7.8%). No recurrence was identified among 65 PA-LNPCPs which underwent margin thermal ablation at SC1 vs 9 (18.0%; P < 0.001) which did not. There were significant differences in resection duration (35 vs 25 minutes; P < 0.001), technical success (93.0% vs 96.6%; P = 0.026), and use of CAST (46.2% vs 7.6%; P < 0.001), between PA-LNPCPs and N-LNPCPs. When adjusting for 2-stage EMR, no difference in technical success was identified (95.6% vs 97.8%; P = 0.100). No differences in adverse events or recurrence were identified. DISCUSSION: EMR, using auxillary techniques where necessary, can achieve high technical success and low recurrence frequencies for PA-LNPCPs.

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Safety and efficacy of a novel powered endoscopic debridement tissue resection device for management of difficult colon and foregut lesions: first multicenter U.S. experience

Cited by 15 publications

References 11 publications

Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience

Over-the-scope-grasper: A new tool for pancreatic necrosectomy and beyond - first multicenter experience

The Over the Scope Grasper – A New Tool for Pancreatic Necrosectomy and Beyond – First Multicenter Experience

Previously Attempted Large Nonpedunculated Colorectal Polyps Are Effectively Managed by Endoscopic Mucosal Resection

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