IS HIGH-PRESSURE INJECTION USEFUL FOR ENDOSCOPIC SUBMUCOSAL DISSECTION? RESULTS OF A RANDOMIZED PROSPECTIVE STUDY COMPARING TWO “SECOND-GENERATION” KNIVES IN A PORCINE MODEL

Aims:

to compare, in terms of efficacy and safety, two second-generation knives with high- or low-pressure injection of fluid.

Methods:

ESD procedures were performed in vivo by three experienced endoscopists, in anesthetized pigs. Four gastric sites of approximately 20 mm diameter were defined and marked using argon plasma coagulation to mimic lesions. Each “lesion” was randomly allocated to an ESD procedure, either with the high-pressure injection knife (HP knife) (HybridKnifeä, Erbe, Germany) or with the low-pressure injection knife (FlushKnifeä, Fujifilm, Japan). Following ESD, animals were sacrificed and the stomach removed for histological examination. Size of resected specimen, duration of procedure, and complications were recorded.

Results:

Twelve “lesions” were resected in three animals, using the HybridKnife (n = 6) or the FlushKnife (n = 6). En bloc resection was achieved in all procedures. Resected specimen size was similar in both groups (25 mm versus 25 mm; p = NS). A trend towards a shorter ESD duration was noted in the HybridKnife group as compared with the FlushKnife group (31 ± 18 min versus 18 ± 10 min; p = 0.15). From the 12 ESD, one minute perforation was observed at histological assessment after a HybridKnife ESD. No complications occurred in the FlushKnife group.

Conclusions:

High-pressure injection allows shorter-duration procedures, but at the cost of one minute perforation. These results need to be confirmed in larger human studies.