Evaluation Of A New Lifting Gel For Endoscopic Submucosal Dissection In An Ex-Vivo Bovine Colon Model: A French Prospective Randomized Study

Aims During endoscopic submucosal dissection (ESD), a lifting solution is injected between the muscularis mucosae and the submucosal layer to create a cushion protecting from the risk of perforation and bleeding. Hydroxyethyl starch (HES) is widely used because it provides a long duration of submucosal lifting with a safe profile. Q-gel is a new lifting solution designed by 3-D matrix (Japan) composed of extracellular matrix peptide. The aim of our study was to evaluate the efficacy of the Q-Gel in colonic ESD compared to HES.

Methods We performed a prospective randomized study evaluating the efficacy of ESD using either Q-Gel or the HES solution performed by two experts in ESD blinded from the solution. To simulate colonic lesions, we used an ex-vivo bovine colon model. Bovine colon was inverted then delineation of a virtual lesion was performed by marking coagulation dots around a plastic disk to obtain a 35 mm lesion. For each lesion, dissection speed and quality, volume injected/surface dissected ratio, perforation rate, and global satisfaction of the operator were determined.

Results Forty ESD were performed (20 with the Q-gel and 20 with the HES solution). Mean dissection speed was 0.79 +/- 0.27 cm²/min in the Q-gel group and 0.63 +/- 0.29 cm²/min in the HES group (p = 0.04). All lesions were resected in one piece with lateral security margine (R0). No perforation was recorded for all the procedures. Mean volume injected/surface dissected ratio was inferior in the Q-gel group than in the HES group (2.02 +/- 0.50 ml/cm² vs 3.19 +/- 1.36 ml/cm² respectively, p = 0.002). In the Q-gel group, global satisfaction was superior than in the HES group.

Conclusions Q-gel increased the dissection speed by 25 % without increasing the risk of perforation and the quality of the resected piece. These interesting results must be confirmed in a human study.

Citation: Lambin T, Rivory J, Ponchon T et al. OP218 EVALUATION OF A NEW LIFTING GEL FOR ENDOSCOPIC SUBMUCOSAL DISSECTION IN AN EX-VIVO BOVINE COLON MODEL: A FRENCH PROSPECTIVE RANDOMIZED STUDY. Endoscopy 2021; 53: S90.

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Artikel online veröffentlicht:
19. März 2021