Endoscopy 2009; 41(4): 340-345
DOI: 10.1055/s-0029-1214473
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Comparison of standard endoscopic submucosal dissection (ESD) versus an optimized ESD technique for the colon: an animal study

N.  Yahagi1 , H.  Neuhaus2 , B.  Schumacher2 , A.  Neugebauer3 , G.  F.  Kaehler4 , M.  Schenk5 , K.  Fischer3 , M.  Fujishiro6 , M.  D.  Enderle3
  • 1Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
  • 2Department of Internal Medicine, Evangelisches Krankenhaus, Düsseldorf, Germany
  • 3Research Department, ERBE Elektromedizin, Germany
  • 4Section of Endoscopy, Surgical University Hospital Mannheim, University of Heidelberg, Germany
  • 5Department of Experimental Medicine, University Hospital Tübingen, University of Tübingen, Germany
  • 6Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Japan
Further Information

Publication History

submitted1 September 2008

accepted after revision23 December 2008

Publication Date:
01 April 2009 (online)

Background and study aims: Endoscopic submucosal dissection (ESD) is a promising therapeutic technique for en bloc resection of large gastrointestinal tumors. However, this technique has disadvantages such as a long intervention time, complexity of the procedure, and a higher rate of complications. The primary aims of the study were to show the feasibility of ESD in the pig colon and to evaluate a new ESD technique comprising the use of a newly developed hybrid knife for colon procedures combining RF (radiofrequency) application and a distance-dependent water-jet application.

Materials and methods: ESD was conducted at three different locations in the colon according to the computer-generated randomization list, using either the standard technique (injection needle, flex knife, and hook knife as therapeutic instruments and DRY CUT and SWIFT COAG as RF currents), or the new ESD technique (hybrid knife as the therapeutic instrument combined with the new cutting mode ENDO CUT D) in 12 healthy pigs. The perforation and bleeding rates were documented and statistically analyzed. Intervention time, resected specimen size, thermal and mechanical damage of the resection bed, and number of instrument changes required were also recorded.

Results: A total of 16 and 18 ESD procedures were performed by the standard and new techniques, respectively. Complete en bloc resection was achieved in all cases. The standard ESD technique showed a perforation rate of 25 % (4/16) whereas the new ESD technique resulted in a 5.5 % perforation rate (1/18) (P = 0.035); bleeding rates were similar. The new ESD technique was significantly safer compared with the standard ESD technique.

Conclusions: A new ESD technique for the successful en bloc resection in thin-walled regions such as pig colon has been described. This procedure is as effective as the standard procedure but is easier to handle and significantly safer.

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N. YahagiMD 

Department of Gastroenterology
Toranomon Hospital

2–2-2 Toranomon
Minato-ku
Tokyo 105–8470
Japan

Fax: +81-3-3582-7068

Email: yahagi-tky@umin.ac.jp