Cold vs Monopolar and Bipolar ESD Technique in Circumferential Esophageal Resection: A Comparative Study in Live Porcine Model

Aims To evaluate if there are differences in the development of stenosis, inflammation and the healing process with different types of electrosurgical dissection currents.

Methods A pilot survival study was carried out in 18 live pigs to compare the rate of esophageal stenosis at 14 days between different types of electrosurgical currents: Cold (C-ESD; n=6), Monopolar (M-ESD; n=6) and Bipolar (B-ESD; n=6) ESD techniques. A hypothetical 50 mm circumferential lesion was marked and resected in the distal esophagus. The inflammatory response was assessed by measuring levels of blood cytokines (proinflammatory IL-1, IL-6, TNF-α and profibrotic TNF-ß) at two-time points: day 0 (pre-procedure) and day 14 (end of survival period). Esophageal diameter was measured by an impedance planimetry probe, obtaining the diameter of the esophagus every 5-mm pre-intervention, and at the end of the survival period. The rate of esophageal volume reduction was calculated by subtracting the final esophageal volume at day 14 from the initial pre-resection volume in each animal, using a dedicated formula. At the end of the survival period, animals were sacrificed, and their esophagus were extracted for histological analysis. Histopathological examination was conducted by blinded pathologists analysing fibrosis (maximal thickness of the submucosal fibrotic tissue in the vertical direction), granulation tissue and neoepithelium formation. Proportion of re-epithelization was evaluated by dividing the length of the re-epithelization and the long axis of the dissected mucosa. Different stains and immunohistochemistry antibodies were used for this purpose.

Results All animals experienced esophageal stricture at the end of follow-up. The percentage of volume reduction was different between techniques: M-ESD 81.8%, B-ESD 76.8% and C-ESD 76.6% (p=0.31). The percentage of reduction (initial diameter to the critical point of stenosis) was also different between techniques: M-ESD 75.8%, B-ESD 77.4% and C-ESD 73.3% (p=0.04). Histological assessments showed less fibrosis in B-ESD group 1.75 mm (1.5-4), M-ESD 1.9 mm (1-5) and C-ESD 3 mm (1-4) (p=0.68), and enhanced re-epithelization in the B-ESD group 15,8%; M-ESD 7,2% and C-ESD 5,5% (p=0.041). The variability in the measurement of inflammatory and profibrotic cytokines between animals and techniques did not allow us to obtain conclusions.

Conclusions Electrosurgical current may play an important role in the development of post-ESD stricture. B-ESD and C-ESD showed a lower percentage of volume reduction while B-ESD showed a less fibrosis thickness and a higher reepithelization proportion rate.

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Artikel online veröffentlicht:
27. März 2025