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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(08): E1207-E1213
DOI: 10.1055/a-1487-5469
Original article

Scissor-type knife improves the safety of endoscopic submucosal dissection (ESD) among endoscopists without experience in ESD: a randomized ex vivo study

Kavel Visrodia
1   Digestive and Liver Diseases, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York, United States
,
Tarek Sawas
2   Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, Texas, United States
,
Liam Zakko
3   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Juan Reyes Genere
4   Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, United States
,
Cadman Leggett
3   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Lori Lutzke
3   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
,
Kenneth K. Wang
3   Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
› Author AffiliationsSupported by: Van Cleve Endowed Professorship NCI U01 CA182940
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Abstract

Background and study aims Endoscopic submucosal dissection (ESD) is technically challenging, difficult to learn, and carries a substantial risk of perforation, all of which remain significant barriers to its adoptability. We aimed to determine whether use of a novel scissor-type knife improved efficacy and safety among novice performers of ESD.

Materials and methods Following a brief didactic session on ESD, participants performed ESD of two lesions (2 cm diameter) in an ex vivo porcine gastric model. One resection was performed with a conventional knife and the other with the scissor knife (order of knife randomized). We recorded procedure time, successful en bloc resection, and adverse events (including full-thickness perforation and muscle injury) for each dissection. Participants completed a post-study survey.

Results 10 endoscopists (8 trainees, 2 staff) considered novices in ESD participated. Compared with the conventional knife, use of the scissor knife was associated with a significantly shorter time to completion of submucosal dissection (mean 6.2 [SD 5.6] vs. 15.6 [SD 15.6] minutes; P = 0.04) and total procedure time was not significantly different (22.1 [SD 13.3] vs. 24.9 [SD 26.5] minutes; P = 0.65). Scissor knife use was also associated with a significantly lower proportion of perforation and/or muscle injury (10.0 % vs. 70.0 %; P < 0.01) and proportion of muscle injury alone (10.0 % vs. 60.0 %; P  = 0.02).

Conclusions Among novices performing ESD on an ex vivo animal model, use of a scissor knife was associated with a significantly lower proportion of adverse events without prolonging procedure time. Scissor-type knives may improve ESD safety, at least among novices.



Publication History

Received: 20 July 2020

Accepted: 19 November 2020

Article published online:
16 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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