Sam Sharma, MD, Hisashi Hara, MD, Miro Peev, MD, Jeffrey Milsom, MD, FACS. Weill Cornell Medical College
Introduction: The established endoscopic submucosal dissection (ESD) technique for removal of large colonic polyps requires pushing of the scope tip, equipped with a plastic cap, under and around the polyp. The cap provides traction and “stand-off” between tissue and the colonoscope camera, but substantially limits the view and subjects it to debris and poor visualisation from electrosurgery. We considered using a Double Balloon (DB) device with independent inflation control and variable distance function to overcome these limitations, in particular providing tissue traction.
We set out to evaluate the standard cap technique versus a novel DB technique (no cap) in performing ESD in an experimental model.
Methods and procedures: Fresh ex-vivo porcine rectosigmoid colon was used in an established “polyp excision” model. Twelve 4 cm mucosal “lesions” were outlined and targeted for complete ESD with a 5 mm margin. Traditional ESD method using a cap technique (n=6) (Olympus cap D-201-12704) or DB method using a novel device (n=6) (DiLumen®, Lumendi, LLC) was performed in an alternate fashion using a pediatric colonoscope (Olympus PCF-H180AL). Monopolar electrosurgery using the ERBE electrosurgical generator with Olympus dualknife (KD-650U) were used in all procedures to remove the “polyp” (80w Cut 40w Coagulation).
Variables measured were time to complete procedure, % completion (procedure time was limited to 80 minutes), clear margins, perforations, and a 6 point scoring system for various parameters relevant to endoscopy (Scoring system: 1=excellent, 2=good, 3=above average, 4=below average, 5=minimal, 6=none). Data was recorded and analysed using Graphpad Prism software. All procedures were recorded (both the endoscopic view and external operator view) and resected specimens (both colon and removed polyp) photographed.
Results:
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By the sixth attempts, time to complete ESD was similar in both techniques (30 vs 33 minutes – red and blue – figure 2). Clear margins were maintained in all specimens. Minor perforations were observed in the DB group during the first 2 attempts, no perforations were observed by the last attempt.
Limitations: Ex-vivo nature of the study, one operator and sample size.
Conclusions: In an experimental ex-vivo ESD colon polypectomy model, an independently controllable DB endoscopic system substantially improved stability and visualization compared with cap-assisted ESD, with a similar safety profile. Despite the early nature of this feasibility study, the DB assisted technique holds promise to expand the capabilities of endoluminal therapy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79249
Program Number: P007
Presentation Session: Poster of Distinction (Non CME)
Presentation Type: PDIST