Comparison of the histopathological effects of two electrosurgical currents in an in vivo porcine model of esophageal endoscopic mucosal resection

Bahin, Farzan F.; Burgess, Nicholas G.; Kabir, Shahrir; Mahajan, Hema; McLeod, Duncan; Subramanian, Vishnu; Pellisé, María; Sonson, Rebecca; Bourke, Michael J.

doi:10.1055/s-0034-1393303

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…We considered that the actual current flowing locally could be approximated by subtracting the standby current from the working current during ESD. The study used a resected porcine esophagus, which may differ from human esophageal tissue 21 . Since there is no thermography that can be used in the esophagus of a living porcine, we conducted this experiment using the extracted esophagus of porcine.…”

Section: Discussionmentioning

confidence: 99%

Lowering the setting value of the esophageal endoscopic submucosal dissection device enabled tissue damage control in vitro porcine model

Yamaguchi

Uesato

Yonemoto

et al. 2022

Sci Rep

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One of the complications of esophageal endoscopic submucosal dissection (ESD) is postoperative stricture formation. Stenosis formation is associated with inflammation and fibrosis in the healing process. We hypothesized that the degree of thermal damage caused by the device is related to stricture formation. We aimed to reveal the relationship between thermal damage and setting value of the device. We energized a resected porcine esophagus using the ESD device (Flush Knife 1.5). We performed 10 energization points for 1 s, 3 s, and 5 s at four setting values of the device. We measured the amount of current flowing to the conducted points and the temperature and evaluated the effects of thermal damage pathologically. As results, the mean highest temperatures for 1 s were I (SWIFT Effect3 Wat20): 61.19 °C, II (SWIFT Effect3 Wat30): 77.28 °C, III (SWIFT Effect4 Wat20): 94.50 °C, and IV (SWIFT Effect4 Wat30): 94.29 °C. The mean heat denaturation areas were I: 0.84 mm2, II: 1.00 mm2, III: 1.91 mm2, and IV: 1.54 mm2. The mean highest temperature and mean heat denaturation area were significantly correlated (P < 0.001). In conclusion, Low-current ESD can suppress the actual temperature and thermal damage in the ESD wound.

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Section: Discussionmentioning

confidence: 99%

Lowering the setting value of the esophageal endoscopic submucosal dissection device enabled tissue damage control in vitro porcine model

Yamaguchi

Uesato

Yonemoto

et al. 2022

Sci Rep

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“…Besides, potassiumcompetitive acid blockers with the advantages of higher acid suppression over conventional PPIs might promote ulcer healing 21,22 Fifth, the cutting current, especially ENDO CUT mode, was reported to attenuate the inflammation and fibrosis of ulcer after esophageal ESD compared with the coagulation current. [23][24][25] Thus, the difference among electrosurgical unit modes might be a potential confounding factor. However, this factor could not be quantified, because different electrosurgical unit modes were used during the procedure, depending on the submucosal condition (e.g.…”

Section: Discussionmentioning

confidence: 99%

Is a proton-pump inhibitor necessary after endoscopic submucosal dissection for superficial esophageal neoplasms? A propensity score analysis

Kanaoka

Iwatsubo

Takeuchi

et al. 2020

Therap Adv Gastroenterol

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Background: Little is known about the efficacy of proton-pump inhibitor (PPI) therapy in the management of esophageal ulcers after endoscopic submucosal dissection (ESD). Therefore, the objective of this study was to investigate the efficacy of PPI in ulcer healing following ESD for superficial esophageal neoplasms, using a propensity score analytic approach. Methods: This retrospective cohort study was conducted at a single referral center. Between April 2005 and August 2015, 199 consecutive patients with superficial esophageal cancer and esophageal dysplasia underwent ESD. For patients with PPI administration, intravenous PPI therapy was commenced immediately after ESD, and oral PPI was administered daily from post-operative day 3, until ulcer healing was identified. We compared the remnant-ulcer rate at 4 weeks after esophageal ESD between the PPI administration and non-PPI groups, using propensity scores and the inverse probability of treatment weighting (IPTW) method. Results: After exclusions, a total of 88 patients were analyzed. The remnant-ulcer rate at 4 weeks after ESD was 25.5% (12/47) and 14.6% (6/41) in the PPI administration and non-PPI groups ( p = 0.21). After adjusting for background factors using IPTW, the risk of a remnant ulcer in the PPI administration group was not decreased significantly compared with that in the non-PPI group [odds ratio (OR) = 2.42, 95% confidence interval (CI): 0.73–7.97, p = 0.15]. Furthermore, PPI therapy did not decrease significantly the remnant-ulcer rate on logistic regression analysis after adjusting for the propensity score (OR = 2.40, 95% CI: 0.69–8.32, p = 0.15). Conclusion: PPI administration does not promote ulcer healing after ESD for superficial esophageal squamous cell carcinoma.

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“…This mode is designed to realize submucosal dissection with lowest tissue damage by combining cutting current and lowest peak voltage coagulation current. Bahin et al examined inflammation after endoscopic mucosal resection and showed that ENDO CUT mode resulted in less inflammation of the submucosal layer and muscle layer than COAG mode 20 . Similar to their result, in our study, lower fibrosis of the muscle layer was observed in ENDO CUT mode than in all coagulation modes.…”

Section: Discussionmentioning

confidence: 99%

“…A limitation of the study is the use of a porcine model which may differ from human in certain aspects. For example, the submucosa and muscle layer are thinner in pigs than in the human esophagus 20 . Damage to the muscle layer, caused by electrocautery, may differ in the human esophagus.…”

Section: Discussionmentioning

confidence: 99%

Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model

et al. 2018

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Background and aim Strictures are a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Post ESD, stricture develops during the process of scar formation, which is related to inflammation caused by ESD. We planned a study to evaluate whether certain electrosurgical unit modes could attenuate strictures after esophageal ESD. Methods A total of 16 ESD, three-quarters of the esophageal circumference, were performed in four live pigs. A ball-tip Flush knife was used for mucosal incision. Submucosal dissection was performed using a Hook knife in monopolar mode and a ball-tip Jet B-knife in bipolar mode. Applied electrosurgical unit modes were FORCED COAG, SWIFT COAG, SPRAY COAG, ENDO CUT in monopolar mode, and FORCED COAG in bipolar mode. One month after ESD, the pigs were killed humanely and the severity of strictures and fibrosis was assessed. Results The resected site in the esophagus showed complete mucosal regrowth and scar formation in all pigs. The quotients of stricture following ENDO CUT, SWIFT COAG, FORCED COAG effect2, FORCED COAG effect3, FORCED COAG effect4, SPRAY COAG, and Bipolar FORCED COAG mode were 16 %, 28 %, 38 %, 33 %, 51 %, 39 %, and 47 %, respectively. The equivalent quotients of fibrosis were 7 %, 28 %, 31 %, 30 %, 35 %, 63 %, and 100 %, respectively. ENDO CUT mode was associated with the lowest mean quotients of stricture and fibrosis. Conclusion ENDO CUT mode showed promising results to attenuate fibrosis and strictures after esophageal ESD.

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Comparison of the histopathological effects of two electrosurgical currents in an in vivo porcine model of esophageal endoscopic mucosal resection

Abstract: In an in vivo porcine survival model of esophageal endoscopic mucosal resection, the use of MCC resulted in significantly less deep thermal ulceration, necrosis, and acute inflammation compared with LPCC. MCC should be used in preference over LPCC for esophageal endoscopic resection.

Cited by 5 publications

References 19 publications

Lowering the setting value of the esophageal endoscopic submucosal dissection device enabled tissue damage control in vitro porcine model

Lowering the setting value of the esophageal endoscopic submucosal dissection device enabled tissue damage control in vitro porcine model

Is a proton-pump inhibitor necessary after endoscopic submucosal dissection for superficial esophageal neoplasms? A propensity score analysis

Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model

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