Takahiro Hiratsuka, MD, Kota Momose, MD, Jeffrey Milsom, MD, Sam Sharma. Weil Cornell Medicine
Introduction: Rectal ESD of lesions on folds or valves is technically difficult, and has an increased perforation risk and en-bloc resection failure. There are limited reports of the use of add-on devices to assist in such techniques. To meet this need we developed a technique to facilitate complex rectal ESD using a new double balloon endoscopic device with retraction in a unique ex-vivo colon model. We set out to compare the traditional cap technique versus a DB with traction technique in performing rectal ESD in an experimental model with a focus on feasibility.
Methods and procedures: Ex-vivo whole porcine colon was used with 3.5 cm mucosal “lesions” outlined on an artificial superior rectal valve 13cm from the anal verge and did not disappear by air inflation. The tissue was mounted in a unique 3D printed model to simulate the borders of the abdomino-pelvic cavity. We targeted complete ESD with a 5mm margin. Traditional cap ESD or DB with traction method using a novel device (Lumendi DiLumen short version) was performed and the videos compared using a colonoscope (EC-530LS, Fujinon). Monopolar electrosurgery using the ERBE electrosurgical generator with Olympus dualknife (KD-650U) were used in all procedures to remove the “polyp” (60w Coagulation).
Results: As the video demonstrates. DB assisted rectal ESD is both technically feasible and offered some benefits over the traditional technique such as tissue retraction capabilities. Intestinal layer discernment was visually improved using our method.
Conclusions: DB assissted rectal ESD with retraction is technical feasible and warrants further examination against traditional cap-assisted ESD methods. Comparison to the traditional TAMIS methods may also be warranted. This feasibility study further adds to evidence of double balloon systems facilitating advanced endolumenal procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86626
Program Number: V094
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo