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BEYOND THE SNARE: TECHNICALLY ACCESSIBLE LARGE EN BLOC COLONIC RESECTION IN THE WEST: AN ANIMAL STUDY
Author(s) -
MOSS ALAN,
BOURKE MICHAEL J,
METZ ANDREW J,
MCLEOD DUNCAN,
TRAN KAYLA,
GODFREY CRAIG,
MCKAY GARY,
CHANDRA ABHILASH P,
PASUPATHY ASOKAN
Publication year - 2012
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2011.01154.x
Subject(s) - medicine , endoscopic submucosal dissection , endoscopic mucosal resection , histopathology , lesion , surgery , resection , pathology
Background: Endoscopic submucosal dissection (ESD) and circumferential submucosal incision endoscopic mucosal resection (CSI‐EMR) are techniques for en bloc excision of large sessile colonic lesions. Our aims were to compare the efficacy, safety and learning curve of colonic hybrid knife (HK) ESD versus CSI‐EMR for en bloc excision of 50 mm diameter hemi‐circumferential artificial lesions in a porcine model. Patients and Methods: Two separate 50 mm diameter areas of normal recto‐sigmoid mucosa were marked out in each of ten pigs. One was excised with HK‐ESD using succinylated gelatin (SG) submucosal injection. The other was isolated with CSI with the Insulated Tip Knife 2 followed by SG submucosal injection then EMR with a large snare. Euthanasia and colectomy was performed at 72 h followed by blinded histopathology assessment. Results: En bloc excision rates were: HK‐ESD 100% versus CSI‐EMR 20% ( P = 0.008). The mean number of resections per lesion was HK‐ESD 1 versus CSI‐EMR 3 ( P = 0.001). The mean dimensions of the largest specimen per technique were HK‐ESD 63 × 54 mm versus CSI‐EMR 49 × 41 mm ( P = 0.005). Procedure duration mean was HK‐ESD 54 min versus CSI‐EMR 22 min ( P < 0.001). When procedure duration was adjusted for the size of the resected en bloc specimen, a statistically significant and accelerated learning effect was noted for HK‐ESD ( r = −0.83, P = 0.003). There were no perforations and no significant bleeding. Conclusions: HK‐ESD with SG submucosal injection is superior to CSI‐EMR for en bloc excision of 50 mm diameter lesions in a porcine model. The technique is rapidly learnt. This novel approach may lower the barrier to colonic ESD for Western endoscopists.