Endoscopy 2019; 51(04): S39-S40
DOI: 10.1055/s-0039-1681286
ESGE Days 2019 oral presentations
Friday, April 5, 2019 11:00 – 13:00: ESD stomach 1 Club A
Georg Thieme Verlag KG Stuttgart · New York

THE USE OF AN ADDITIONAL WORKING CHANNEL (AWC) IN ENDOSCOPIC MUCOSAL RESECTION (EMR+) COMPARED TO CONVENTIONAL EMR

RF Knoop
1   Gastroenterology and GI Oncology, University Medical Center, Göttingen, Germany
,
E Wedi
1   Gastroenterology and GI Oncology, University Medical Center, Göttingen, Germany
,
V Ellenrieder
1   Gastroenterology and GI Oncology, University Medical Center, Göttingen, Germany
,
A Neesse
1   Gastroenterology and GI Oncology, University Medical Center, Göttingen, Germany
,
S Kunsch
1   Gastroenterology and GI Oncology, University Medical Center, Göttingen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Endoscopic mucosal resection (EMR) can be enhanced by a new external additional working channel (AWC, Ovesco Endoscopy, Tuebingen, Germany) to “EMR+”. The AWC is mounted on a standard endoscope similar to the setup known from the full-thickness resection device (FTRD). So far, we do not have much data evaluating EMR+. We compared EMR+ to the gold standard of classical EMR.

Methods:

The trial was conducted prospectively in an ex-vivo animal model with pig stomachs placed into the EASIE-R simulator (Endosim, Hudson, USA), a well-established model for research and endoscopic training.

Prior to intervention, we set standardized lesions, measuring 1 cm, 2 cm, 3 cm or 4 cm. In all resections, a 33 mm snare (Boston Scientific Captivator) and an FTRD grasper (Ovesco Endoscopy) was used.

Results:

Overall, 152 procedures were performed. In lesions of 1 cm, both EMR and EMR+ were very reliable with a R0 resection rate of 100%. In 2-cm lesions, EMR already dropped to 54,55%. Classical EMR did not provide sufficient resection rates for lesions with 3 cm or even 4 cm (18,18% and 0%). EMR+ still presented very satisfying results in 3 cm-lesions (86,36%) but also relevantly decreased at 4 cm (60,00%). Moreover, we observed a perforation rate of 15% in the latter.

Conclusions:

EMR+ enables a grasp-and-snare technique and consequently facilitates en-bloc resection of larger lesions compared to conventional EMR, which shows its advantages in the resection of lesions < 2 cm. Consistently, we found no additional benefit of EMR+ in these lesions. From a size of 2 cm, EMR+ outdoes its advantages, especially concerning the rate of R0 resections. At 3 cm, EMR+ reaches its best discriminatory power. At 4 cm, also EMR+ comes to its inherent limits and the risk of perforations rises. Then, ESD or surgery should be considered.

EMR+ could help to close a therapeutic gap in interventional endoscopy with manageable technical complexity, time and costs.