Usefulness of the flexible traction method in gastric endoscopic submucosal dissection: an in-vivo animal study
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Usefulness of the flexible traction method in gastric endoscopic submucosal dissection: an in‑vivo animal study Kazutoshi Higuchi1 · Osamu Goto1 · Eriko Koizumi1 · Kumiko Kirita1 · Hiroto Noda1 · Teppei Akimoto1 · Jun Omori1 · Mitsuru Kaise1 · Katsuhiko Iwakiri1 Received: 20 February 2020 / Accepted: 24 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background An appropriate traction of the target lesion is a key for a safe and secure ESD procedure. We proposed the flexible traction method (F-trac) which provided an optimal traction using an endoscopic hand-suturing (EHS) and investigated the usefulness of this technique for gastric ESD in-vivo porcine model. Methods In the F-trac method, a lesion was suspended by pulling proximal side of endoscope which was connected to the contralateral side with a barbed suture using the EHS technique just before starting the submucosal dissection. A single endoscopist performed conventional ESD (C-ESD) and F-trac ESD alternately for a total of ten simulating lesions of 3 cm in diameter in a live porcine stomach. The pig was rotated so that each lesion was positioned in the direction of the gravity. The procedure time, technical accuracy, adverse events, and the number of additional injection to the submucosal layer during dissection were evaluated. Results The total ESD procedure time in the F-trac group was significantly shorter than in C-ESD group (19.0 min vs. 30.6 min, p = 0.039). There were no significant differences between both groups in muscular layer damage, sample damage, perforation, and intraoperative bleeding. The number of additional injection in the F-trac group was significantly fewer than that in C-ESD group (0 times vs. 4.4 times, p = 0.027). Conclusions In gastric ESD, F-trac might be useful for shortening the total procedure time. This method can facilitate optimal traction without disturbing the endoscopic visualization and the movement of endoscope. Keywords Endoscopic hand-suturing · Endoscopic submucosal dissection · Traction Abbreviations ESD Endoscopic submucosal dissection EMR Endoscopic mucosal resection EHS Endoscopic hand-suturing F-trac Flexible traction C-ESD Conventional endoscopic submucosal dissection SD Standard deviation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07850-8) contains supplementary material, which is available to authorized users. * Kazutoshi Higuchi k‑[email protected] 1
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, 1‑1‑5, Sendagi, Bunkyo‑ku, Tokyo 113‑8603, Japan
With the spread of endoscopes and the development of endoscopic techniques, diseases that can be treated with flexible endoscopes are increasing and the indication for endoscopic therapies is also expanding. Endoscopic submucosal dissection (ESD) has already been accepted around the world, especially in Asian countries [1]. ESD has a higher en bloc r
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