SPEEDBOAT ASSISTED ENDOSCOPIC SUBMUCOSAL DISECTION FOR GIANT COLON POLYPS: INTERIM FIRST RESULTS OF SSD /AuditRegistry

Aims Speedboat™ is a novel multimodal endosurgical device. It utilizes the use of advanced bipolar energy for cutting/dissection and high frequency microwave energy for coagulation. This study aims to evaluate the efficacy of Speedboat assisted Endoscopic Submucosal Dissection (S-ESD) in the management of large complex colorectal polyps as well as the speed of dissection.

Methods Data, from a prospectively collected clinical audit and later a dedicated S-ESD registry (2018-2024) was analyzed. All cases were assessed in the Complex Polyp Multi-Disciplinary Meeting. Lesions characteristics, long and short axis length, time of dissection and clinical outcomes were collected. Lesion surface (cm²) and Speed (cm2/hr) were calculated. Lesions with a surface of 30 cm² and above were deemed as “giant”. Clinical outcomes and dissection speed were compared between giant and non-giant polyps.

Results Over the study period, a total of 284 consecutive patients [56.3% male, age 72 (IQR: 65-77)] had a colorectal lesion completely excised using S-ESD with median surface of 12.56cm² (IQR:6.87-21.49), long axis 5,0 cm (IQR: 3.5-6.5) and speed 8.95 cm2/hr (IQR:6.80-14.60).

44 patients [45.5% male, age 73 (IQR 67-77)] had “giant lesions” removed with median surface of 50.14cm² (IQR:37.68-75.04) and long axis 9.5cm (IQR: 8.0-11.8). The remaining 240 patients with “non-giant lesions” (58.3% male, age 72, IQR:63-77) had median surface 10.59cm2 (IQR: 6.28-16.48) and long axis 4.5 cm (IQR: 3.5-5.72). No statistically significant difference in regards with age and gender was found between the two groups.

Speed of dissection was 16.28 cm²/h (IQR:12.92-24.22) in the giant group, significantly higher than the one in the non-giant group 8.24cm/² (IQR: 6.53- 12.56) (p<0.001).

Similar percentage of lesions in both “Giant” (27.9%) and “Non-Giant” (26.9%) lesions had severe (F2) submucosal fibrosis (p=0.889).

The intraprocedural bleeding rate was 9.0% in the non-giant group and 9.3% in the giant group (p=0.952). Delayed bleeding in the non-giant group was 1.7% whereas in the giant group was 7% (p=0.044). Incidence of other delayed complications including post polypectomy syndrome and vasovagal attack, was 3.5% in the non-giant and 4.8% in the giant group (p=0.680). There were no perforations in any of the groups.

Conclusions Speedboat assisted endoscopic submucosal dissection is a safe, effective and efficient technique for en-bloc excision of average and giant colorectal lesions. Speed of dissection is higher in larger lesions, even in fibrotic lesions.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

Publication History

Article published online:
27 March 2025