A novel endoscopic technique and device for bimanual rectosigmoidal ESD

Aims Colorectal endoscopic submucosa dissection (ESD) is demanding and associated with a substantial risk of perforation. Key to increasing effectiveness and safety is to apply countertraction during resection. In this study, we present a novel endoscopic device developed to facilitate rectosigmoidal ESD by combination of rigid instruments and flexible endoscopy.

Methods The device includes a transanal port system and a specially developed grasper. Objectives of this preclinical study were to assess feasibility and compare the technique to conventional ESD. Overall, 32 ESD procedures were performed on explanted porcine colon; 16 by ESD novices (group 1) and 16 by ESD experts (group 2). Eight of these were each performed using conventional ESD technique and eight using the new device in different localizations (predefined resection area of 12.6 cm²). Procedural time, technical success and rates of muscularis injuries and perforations were assessed.

Results Mean total procedure time for EndoTEM versus conventional ESD was 126 vs. 146 min (p= 0.244, group 1) and 46 vs. 90 min (p= <0.001, group 2); mean time for resection (excluding circumferential incision) was 53 vs. 92 min (p= 0.023, group 1) and 26 vs. 71 min (p= <0.001, group 2). Overall, no perforation or muscularis lesion (ML) occurred using EndoTEM (vs. 24 perforations and 73 ML in conventional ESD); all resections were complete.

Conclusions Rectosigmoidal ESD using EndoTEM is feasible and safe. Compared to conventional ESD, the technique significantly reduced procedure time and risk of perforation in this ex vivo study.

 

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Conflicts of interest

Arthur Schmidt and Armin Kuellmer received lecture fees (Ovesco)

Publication History

Article published online:
14 April 2023