New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos)

Kantsevoy, Sergey V.; Bitner, Marianne; Piskun, Gregory

doi:10.1007/s00464-015-4544-8

Cited by 36 publications

(20 citation statements)

References 26 publications

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“…Many approaches have been tested to accelerate and secure endoscopic resections. For the purpose of achieving better intraluminal tissue traction, various endoscopic devices have been designed, including external forceps, magnetic anchors, clips with attached strings, rubber bands, the EndoLifter, and the creation of a pulley system with clips to facilitate endoscopic traction [15,[21][22][23][24][25][26][27]. However, the optimal traction device for endoluminal surgery has not been identified so far.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection with an additional working channel (ESD+): a novel technique to improve procedure time and safety of ESD

et al. 2020

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Background and aims A new external additional working channel (AWC) was recently introduced by which endoscopic submucosal dissection (ESD) can be converted to a technique termed "ESD+ ". We aim to systematically evaluate this novel technique in flat gastric lesions and compare it to classical ESD. Methods The study was prospectively conducted in a pre-clinical ex vivo animal model (EASIE-R simulator) with porcine stomachs. Prior to intervention, we set standardized lesions measuring 3 cm or 4 cm in antegrade as well as in retrograde positions. Results Overall, 64 procedures were performed by an experienced endoscopist. Both techniques were reliable and showed en bloc resection rates of 100%. Overall, ESD+ reduced time of procedure compared to ESD (24.5 vs. 32.5 min, p = 0.025*). Particularly, ESD+ was significantly faster in retrograde lesions with a median of 22.5 vs. 34.0 min in 3 cm retrograde lesions (p = 0.002*) and 34.5 vs. 41.0 min (p = 0.011*) in 4 cm retrograde lesions. There were 0 perforations with both techniques. In ESD+ , 1 muscularis damage occurred (3.13%) compared to 6 muscularis damages with ESD (18.75%, p = 0.045*). Conclusions By its grasp-and-mobilize technique, ESD+ allows potentially faster and safer resections of flat gastric lesions compared to conventional ESD in an ex vivo porcine model. The potential advantages of ESD+ in terms of procedure time may be particularly relevant for difficult lesions in retrograde positions.

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Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection with an additional working channel (ESD+): a novel technique to improve procedure time and safety of ESD

et al. 2020

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“…There is an array of devices being developed as adjuncts to ESD performance. This includes platform devices to allow a variety of instruments to be used synergistically similar to the operating room setup[ 68 ]. Balloon devices can allow stabilization of the colonoscope during ESD, and this includes the traditional double balloon endoscope and the DiLumen device (expressively developed for ESD)[ 69 ].…”

Section: Challeneges For Western Esd Operatormentioning

confidence: 99%

Introduction of endoscopic submucosal dissection in the West

Friedel¹,

Stavropoulos²

2018

WJGE

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Endoscopic submucosal dissection (ESD) is well established in Asia as a modality for selected advanced lesions of both the upper and lower gastrointestinal tract, but ESD has not attained the same niche in the West due to a variety of reasons. These include competition from traditional surgery, minimally invasive surgery and endoscopic mucosal resection. Other obstacles to ESD introduction in the West include time commitment for learning and doing procedures, a steep learning curve, special equipment, lack of mentors, cost issues, interdisciplinary conflicts, concern regarding complications and lack of support from institutions and interfacing departments. There are intrinsic differences in pathology prevalence (e.g., early gastric cancer) between the two regions that are less conducive for ESD implementation in the West. We will elaborate on these issues and suggest measures as well as a protocol to overcome these obstacles and hopefully allow introduction of ESD as a tenable option for appropriate patients.

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“…Several promising approaches were already tried for achieving an eased work setting 8 . Yet the approved devices are either only fitting for specific indications in the rectum or, as with the Endolifter (Olympus), possible manipulation of the mucosa is limited to solely retraction 9 10 . In certain centers, ESD is also performed by tunneling techniques or counter-traction with dental floss by clip and string technique.…”

Section: Discussionmentioning

confidence: 99%

Improved endoscopic resection of large flat lesions and early cancers using an external additional working channel (AWC): a case series

et al. 2019

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Background En-bloc resection of large, flat lesions or early stages of cancer is challenging. No bimanual tasks are possible using standard endoscopes. Dual-channel endoscopes are not available everywhere and have a small distance between the channels. Patients and methods A new external additional working channel (AWC) (Ovesco, Tuebingen, Germany) was designed and developed potentially enabling bimanual tasks. Fixed to the tip of a standard gastroscope or pediatric colonoscope, a second endoscopic tool can be inserted through the AWC and used for tissue retraction during endoscopic resection. Results In the upper and lower gastrointestinal tract, endoscopic mucosal resection (EMR) with a modified grasp-and-snare technique and endoscopic submucosal dissection (ESD) were performed successfully using the AWC in eight patients. Complications were acute arterial bleeding post-EMR in two cases treated by endoscopic clipping. Conclusions We conclude that a newly developed external additional working channel (AWC) enables endoscopic resection of large lesions in the upper and lower gastrointestinal tract. Potential benefits are its suitability for EMR and ESD, no need for a dual-channel endoscope and an adjustable distance of working channels.

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New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos)

Cited by 36 publications

References 26 publications

Endoscopic submucosal dissection with an additional working channel (ESD+): a novel technique to improve procedure time and safety of ESD

Endoscopic submucosal dissection with an additional working channel (ESD+): a novel technique to improve procedure time and safety of ESD

Introduction of endoscopic submucosal dissection in the West

Improved endoscopic resection of large flat lesions and early cancers using an external additional working channel (AWC): a case series

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