CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(06): E739-E744
DOI: 10.1055/a-0578-8081
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Antigravity ESD – double-balloon-assisted underwater with traction hybrid technique

Sam K. Sharma
Minimally Invasive New Technologies, Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
,
Takahiro Hiratsuka
Minimally Invasive New Technologies, Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
,
Hisashi Hara
Minimally Invasive New Technologies, Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
,
Jeffrey W. Milsom
Minimally Invasive New Technologies, Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States
› Author Affiliations
Further Information

Publication History

submitted 03 July 2017

accepted after revision 05 February 2018

Publication Date:
05 June 2018 (online)

Abstract

Background and study aims Complex colorectal polyps or those positioned in difficult anatomic locations are an endoscopic therapeutic challenge. Underwater endoscopic submucosal dissection (UESD) is a potential technical solution to facilitate efficient polyp removal. In addition, endoscopic tissue retraction has been confined to limited methods of varying efficacy and complexity. The aim of this study was to evaluate the efficiency of a unique UESD technique for removing complex polyps using double-balloon-assisted retraction (R).

Materials and methods Using fresh ex-vivo porcine rectum, 4-cm polyps were created using electrosurgery and positioned at “6 o’clock” within an established ESD model. Six resections were performed in each group. Underwater techniques were facilitated using a novel double-balloon platform (Dilumen, Lumendi, Westport, Connecticut, United States).

Three different polypectomy methods were compared: 1. UESD with retraction (UESD-R), 2. UESD, 3. Traditional cap-assisted ESD technique.

Results UESD-R had a significantly shorter total procedural time than cap-assisted ESD and UESD alone (24 vs. 58 vs. 56 mins). UESD-R produced a dissection time on average of 5 minutes, attributed to the retraction provided. There was also a subjective significant reduction in electrosurgical smoke with the underwater techniques contributing to improved visualization.

Conclusions Here we report the first ex-vivo experience of a unique double-balloon endoscopic platform optimized for UESD with tissue traction capability. UESD-R removed complex lesions in significantly shorter time than conventional means. The combined benefits of UESD and retraction appeared to be additive when tackling complex polyps and should be studied further.