CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(03): E376-E381
DOI: 10.1055/s-0043-122883
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model

Yusuke Tonai
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Ryu Ishihara
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Yasushi Yamasaki
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Masamichi Arao
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Taro Iwatsubo
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Minoru Kato
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Syo Suzuki
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Kenta Hamada
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Satoki Shichijo
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Noriko Matsuura
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Takashi Kanesaka
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Hiroko Nakahira
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Sachiko Yamamoto
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Tomofumi Akasaka
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Noboru Hanaoka
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Yoji Takeuchi
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Koji Higashino
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Noriya Uedo
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Yasuhiko Tomita
2  Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
,
Hiroyasu Iishi
1  Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
› Author Affiliations
Further Information

Publication History

submitted 30 May 2017

accepted after revision: 25 October 2017

Publication Date:
07 March 2018 (online)

Abstract

Background and aim Strictures are a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Post ESD, stricture develops during the process of scar formation, which is related to inflammation caused by ESD. We planned a study to evaluate whether certain electrosurgical unit modes could attenuate strictures after esophageal ESD.

Methods A total of 16 ESD, three-quarters of the esophageal circumference, were performed in four live pigs. A ball-tip Flush knife was used for mucosal incision. Submucosal dissection was performed using a Hook knife in monopolar mode and a ball-tip Jet B-knife in bipolar mode. Applied electrosurgical unit modes were FORCED COAG, SWIFT COAG, SPRAY COAG, ENDO CUT in monopolar mode, and FORCED COAG in bipolar mode. One month after ESD, the pigs were killed humanely and the severity of strictures and fibrosis was assessed.

Results The resected site in the esophagus showed complete mucosal regrowth and scar formation in all pigs. The quotients of stricture following ENDO CUT, SWIFT COAG, FORCED COAG effect2, FORCED COAG effect3, FORCED COAG effect4, SPRAY COAG, and Bipolar FORCED COAG mode were 16 %, 28 %, 38 %, 33 %, 51 %, 39 %, and 47 %, respectively. The equivalent quotients of fibrosis were 7 %, 28 %, 31 %, 30 %, 35 %, 63 %, and 100 %, respectively. ENDO CUT mode was associated with the lowest mean quotients of stricture and fibrosis.

Conclusion ENDO CUT mode showed promising results to attenuate fibrosis and strictures after esophageal ESD.