Endoscopic submucosal dissection by using a flexible Maryland dissector: a randomized, controlled, porcine study (with videos) - 24/08/11
Reprint requests: Richard I. Rothstein, MD, Professor of Medicine, Dartmouth College, Chief, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756Résumé |
Background |
Endoscopic submucosal dissection (ESD) is a minimally invasive method for en bloc removal of GI lesions. Current ESD methods and devices have limitations, including long procedure times, technical difficulty, safety, and availability.
Objective |
The aim of this study was to evaluate a blunt submucosal dissection technique and compare it with ESD by using the insulated-tip (IT) knife.
Design |
Randomized, controlled, animal study.
Setting |
Animal facility laboratory.
Intervention |
Twelve gastric lesions were marked by using electrocautery. After submucosal injection, a circumferential mucosal incision was created. ESD was then performed by using either the IT knife 2 (n = 6) or the flexible endoscopic Maryland dissector (n = 6).
Main Outcome Measurements |
Median time for IT knife ESD versus median time for Maryland dissector ESD.
Results |
Median time (IQR) for IT knife ESD was 43 minutes (range 36-50 minutes). The median time (IQR) for Maryland dissector ESD was 32 minutes (range 22-41 minutes; P = .09). The resection specimens obtained with the Maryland dissector tended to be larger, with a median (IQR) of 20.2 cm2 (range 16.4-23 cm2) when compared with specimens resected with the IT knife, which yielded a median (IQR) resection area of 15.9 cm2 (14.8-18.7 cm2; P = .08). Complete en-bloc resection including all of the electrocautery markings was achieved in all cases. There were no perforations. There were two minor hemorrhages in the IT knife group and 3 in the Maryland dissector group.
Limitations |
Nonsurvival setting, small sample size.
Conclusion |
The flexible Maryland dissector was demonstrated to be efficient, safe, and feasible for facilitating gastric ESD in a live animal model.
Le texte complet de cet article est disponible en PDF.Abbreviations : ESD, IQR, IT
Plan
| DISCLOSURE: R. Rothstein disclosed that he has a consulting relationship with Ethicon Endosurgery. All other authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr Rothstein at richard.rothstein@dartmouth.edu. |
Vol 71 - N° 6
P. 1056-1062 - mai 2010 Retour au numéro
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