Clin Endosc.  2015 May;48(3):221-227. 10.5946/ce.2015.48.3.221.

The Efficacy of an Endoscopic Grasp-and-Traction Device for Gastric Endoscopic Submucosal Dissection: An Ex Vivo Comparative Study (with Video)

• Scholvinck DW
• Goto O
• Bergman JJ
• Yahagi N
• Weusten BL

• KMID: 2148570
• DOI: http://doi.org/10.5946/ce.2015.48.3.221

Abstract

BACKGROUND/AIMS
To investigate whether the EndoLifter (Olympus), a counter-traction device facilitating submucosal dissection, can accelerate endoscopic submucosal dissection (ESD).
METHODS
Two endoscopists (novice/expert in ESD) performed 64 ESDs (artificial 3-cm lesions) in 16 ex vivo pig stomachs: per stomach, two at the posterior wall (forward approach) and two at the lesser curvature (retroflex approach). Per approach, one lesion was dissected with (EL+) and one without (EL-) the EndoLifter. The submucosal dissection time (SDT), corrected for specimen size, and the influence of ESD experience on EndoLifter usefulness were assessed.
RESULTS
En bloc resection rate was 98.4%. In the forward approach, the median SDT was shorter with the EndoLifter (0.56 min/cm2 vs. 0.91 min/cm2), although not significantly (p=0.09). The ESD-experienced endoscopist benefitted more from the EndoLifter (0.45 [EL+] min/cm2 vs. 0.68 [EL-] min/cm2, p=0.07) than the ESD-inexperienced endoscopist (0.77 [EL+] min/cm2 vs. 1.01 [EL-] min/cm2, p=0.48). In the retroflex approach, the median SDTs were 1.06 (EL+) and 0.48 (EL-) min/cm2 (p=0.16). The EndoLifter did not shorten the SDT for the ESD-experienced endoscopist (0.68 [EL+] min/cm2 vs. 0.68 [EL-] min/cm2, p=0.78), whereas the ESD-inexperienced endoscopist seemed hindered (1.65 [EL+] min/cm2 vs. 0.38 [EL-] min/cm2, p=0.03).
CONCLUSIONS
In gastric ESD, the EndoLifter, in trend, shortens SDTs in the forward, but not in the retroflex approach. Given the low numbers in this study, a type II error cannot be excluded.

Keyword

Endoscopic submucosal dissection; EndoLifter; Stomach neoplasms; Gastric mucosa; Swine

MeSH Terms

Gastric Mucosa
Stomach
Stomach Neoplasms
Swine

Figure

• 

  Fig. 1 The EndoLifter (Olympus). (A) The EndoLifter mounted on the tip of an endoscope. (B) Grasping forceps proceeding forward over the tip of the endoscope and opening.

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  Fig. 2 Experimental set-up. (A) A training kit and the EndoLifter (Olympus). A porcine stomach with the esophagus in a training model, tied with sutures and a glass loop. (B) Per stomach, four artificial lesions (3 cm) are created: I and II at the lesser curvature (retroflex approach) and III and IV at the posterior wall (forward approach).

• 

  Fig. 3 Experimental set-up II. Flowchart of the study.

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