EVALUATION OF A NEW DEMILUNE SHAPED DEVICE FOR RAPID ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD)

Aims:

ESD has been established as an effective treatment option for early gastrointestinal cancer. To date, various devices for ESD are available. Most recently, a novel, demilune shaped device was introduced potentially allowing for fast submucosal cutting due to its special design which allows rapid movements of the device above the muscle layer. I addition, the device allows for selective grasping of the vessels thereby enabling ad hoc haemostasis.

Primary objective of the study was to evaluate the efficacy and learning curve of a newly developed demilune shaped device for ESD.

Methods:

Ex vivo porcine models were utilized in an advanced endoscopic simulator of interventional endoscopy. Artificial lesions, each 2 × 2 cm in size, were created in fresh ex vivo porcine stomachs at the fundus, corpus and antrum. ESD was performed after marking of the lesions with the ESD instrument, followed by lifting of the mucosa with submucosal injection of colored saline. Afterwards, circular incision of the lesions was performed with the new ESD-instrument. For resection, the submucosa was lifted with a distal clear cap and cut with the new demilune device. Resection specimens were retrieved to evaluate if all marks were included (R0).

Results:

Average size of removed lesions was 30 mm. En-bloc resection rate was 100% and R0 resection rate was 95%. Mean total procedure time was 25 minutes and not dependent on the location. No perforations occurred during the study despite the rapid dissection speed through the submucosa. Satisfaction of the endoscopist and the supporting nurse staff was high throughout all cases.

Conclusions:

The new demilune shaped device for ESD allows for rapid dissection of the submucosa due to its inherent design. Further studies should are now focusing on in vivo studies to confirm these initial results.