Z Gastroenterol 2018; 56(08): e373
DOI: 10.1055/s-0038-1669117
Kurzvorträge
Endoskopie und minimalinvasive Chirurgie
ESD: Technik und Ergebnisse – Donnerstag, 13. September 2018, 12:30 – 13:42, 21b
Georg Thieme Verlag KG Stuttgart · New York

Preliminary report of a new demilune device for rapid endoscopic submucosal dissection (ESD)

H Neumann
1   Universitätsmedizin Mainz, Interdisziplinäre Endoskopie, Mainz, Deutschland
,
T Zimmermann
1   Universitätsmedizin Mainz, Interdisziplinäre Endoskopie, Mainz, Deutschland
,
P Grimminger
2   Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Mainz, Deutschland
,
F Rahman
1   Universitätsmedizin Mainz, Interdisziplinäre Endoskopie, Mainz, Deutschland
,
F Thieringer
1   Universitätsmedizin Mainz, Interdisziplinäre Endoskopie, Mainz, Deutschland
,
PR Galle
1   Universitätsmedizin Mainz, Interdisziplinäre Endoskopie, Mainz, Deutschland
,
W Kneist
2   Universitätsmedizin Mainz, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Mainz, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
13 August 2018 (online)

 

Introduction:

ESD has been established as an effective treatment option for early gastrointestinal cancer. To date, various devices for ESD are available. Most recently, a novel, demilune device was introduced potentially allowing for fast submucosal cutting due to its special design which allows rapid movements of the device above the muscle layer. In addition, the device can be opened like a scissor therefore also acting for hemostasis.

Aims and Methods:

Primary objective of the study was to evaluate the efficacy and learning curve of a newly developed demilune device for ESD.

We performed a prospective study evaluating the novel ESD device. First, ex vivo porcine models were utilized in an advanced endoscopic simulator of interventional endoscopy. After the initial learning curve, the study was repeated in living pigs under general anesthesia. For both study arms, artificial lesions, each 25 × 25 mm in size, were created in the fundus, corpus and antrum of the stomach. ESD was performed after marking of the lesions with the ESD instrument, followed by lifting of the mucosa with submucosal injection of colored saline. Afterwards, circular incision of the lesions was performed with the new ESD-instrument. For resection, the submucosa was lifted with a distal clear cap and cut with the new demilune device. Resection specimens were retrieved to evaluate if all marks were included (R0).

Results:

Average size of removed lesions was 30 mm. En-bloc resection rate was 100% and R0 resection rate was 95%. Mean total procedure time was 25 minutes and not dependent on the location or if the resection was performed in ex vivo models or in vivo. No perforations occurred during the study despite the rapid dissection speed through the submucosa. Satisfaction of the endoscopist and the supporting nurse staff was high throughout all cases.

Conclusion:

The new demilune device for ESD seems to be a safe and efficient new instrument for ESD allowing for rapid dissection of the submucosa due to its inherent design. Further studies should now focus on human trials to confirm these promising results.