Clin Endosc.  2021 Jul;54(4):555-562. 10.5946/ce.2020.229.

Diode Laser—Can It Replace the Electrical Current Used in Endoscopic Submucosal Dissection? (with Video)

• Jung Y
• Baik GH
• Ko WJ
• Ko BM
• Kim SH
• Jang JS
• Jang JY
• Lee WS
• Cho YK
• Lim SG
• Moon HS
• Yoo IK
• Cho JY

• KMID: 2518859
• DOI: http://doi.org/10.5946/ce.2020.229

Abstract

Background/Aims
A new medical fiber-guided diode laser system (FDLS) is expected to offer high-precision cutting with simultaneous hemostasis. Thus, this study aimed to evaluate the feasibility of using the 1,940-nm FDLS to perform endoscopic submucosal dissection (ESD) in the gastrointestinal tract of an animal model.
Methods
In this prospective animal pilot study, gastric and colorectal ESD using the FDLS was performed in ex vivo and in vivo porcine models. The completeness of en bloc resection, the procedure time, intraprocedural bleeding, histological injuries to the muscularis propria (MP) layer, and perforation were assessed.
Results
The en bloc resection and perforation rates in the ex vivo study were 100% (10/10) and 10% (1/10), respectively; those in the in vivo study were 100% (4/4) and 0% for gastric ESD and 100% (4/4) and 25% (1/4) for rectal ESD, respectively. Deep MP layer injuries tended to occur more frequently in the rectal than in the gastric ESD cases, and no intraprocedural bleeding occurred in either group.
Conclusions
The 1,940-nm FDLS was capable of yielding high en bloc resection rates without intraprocedural bleeding during gastric and colorectal ESD in animal models.

Keyword

Endoscopic mucosal resection; Hemostasis; Lasers; Perforation

Figure

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  Fig. 1. Laser devices. (A) 1,940-nm wavelength diode laser system. (B) Fiber optic laser catheter.

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  Fig. 2. Results of colonic endoscopic submucosal dissection in the ex vivo model.

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  Fig. 3. Endoscopic submucosal dissection using the fiber-guided diode laser system in the ex vivo model. (A) Creation of artificial lesion 3 cm in diameter using an endoscopic ruler. (B) Submucosal dissection using the fiber optic laser catheter. (C) Remaining porcine colon tissue bed after endoscopic resection. (D) Specimen spread and pinned on cork plates immediately after resection.

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  Fig. 4. Endoscopic submucosal dissection using the fiber-guided diode laser system in the in vivo model. (A) Circumferential incision performed outside the margins of the target lesion. (B) Submucosal dissection using the fiber optic laser catheter. (C) Completely resected target lesion.

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  Fig. 5. Histopathological examination in the in vivo study. (A) Resected colon tissue specimen (hematoxylin and eosin staining, ×12.5 magnification), (B) remainder of the stomach after endoscopic resection (hematoxylin and eosin staining, ×12.5 magnification).

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