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

Abstract

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.

Prospective multicenter study of the esophageal triamcinolone acetonide‐filling method in patients with subcircumferential esophageal endoscopic submucosal dissection

“…Two patients with submucosal invasive cancer also underwent chemoradiation therapy for possible lymph node metastasis after complete re-epithelialization. Median (range) follow-up period was 18 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) months. None of the patients showed esophageal perforation or mediastinal emphysema as a result of muscle injury during ESD.…”

“…The electrosurgical unit and knife for ESD consisted of a high‐frequency generator (VIO300; ERBE Elektromedizin, Tübingen, Germany), the HookKnife and the DualKnife (Olympus Co.). Submucosal dissection was carried out with the autocut mode (60 W, effect, 5) to decrease the burning effect on the resected surface, which could reportedly cause severe stenosis after extensive esophageal ESD . The coagulation mode was used only to stop bleeding and for preventive vascular coagulation.…”

“…Submucosal dissection was carried out with the autocut mode (60 W, effect, 5) to decrease the burning effect on the resected surface, which could reportedly cause severe stenosis after extensive esophageal ESD. 21,22 The coagulation mode was used only to stop bleeding and for preventive vascular coagulation. Figure 1 (A) Horizontal resection grades of subcircumferential endoscopic submucosal dissection.…”

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

“…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.…”

Endoscopic submucosal dissection: an update on tools and accessories

“…ERBE Elektromedizin GmbH (Tübingen, Germany) manufactures the ICC series as well as the VIO 300D. Cut modes include Auto Cut (standard), Endo Cut (with some coagulation effect – better for fibrosis/strictures 79 ), and Dry Cut (high power mode for faster cutting). Coagulation modes include Swift Coag (similar to Dry Cut with more haemostasis), Forced Coag (higher voltage – can be used for submucosal dissection), Spray Coag (non-contact surface coagulation with low penetration – good for post procedure haemostasis) and Soft Coag (low voltage resulting in coagulation only with no cutting).…”