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Double Balloon Underwater ESD

Hisashi Hara, MD, Sam Sharma, MD, Jeffrey Milsom, MD, FACS. Weill Cornell Medical College

Introduction: Underwater ESD was developed to improve visualization whilst performing the procedure and minimize burn artifact using water as a heat sink.

It’s utility in the colon is limited due to lack of fluid containment within the intestine.

A double balloon system may be advantageous in this situation – forming a water-tight area between the two balloons.

We considered using a Double Balloon (DB) device with independent inflation control and variable distance function to overcome these limitations, in particular providing a water-tight seal.

Aims: To evaluate the technical feasibility and safety in an ex-vivo recto-sigmoid intestine model.

Materials and Methods: A 3cm diameter virtual lesion 20cm from the anal verge was marked using electrosurgery on the mucosal surface of ex-vivo porcine recto-sigmoid intestine.

Double-balloon underwater assisted ESD was performed by:

Olympus PCF180AL colonoscope.

DiLumen® device (Lumendi, LLC).

ERBE electrosurgical generator.

No ESD cap was used.

The procedure was recorded (both endoscopic and external views).

Results: Complete resection of the lesion was achieved with no perforations. Visibility was enhanced.

Conclusions: Double balloon assisted underwater ESD is technically feasible.

This technique may have superiority over conventional ESD techniques e.g. visualization.

This remains a novel method, currently in a state of evolution.

Despite the early nature of this feasibility study, DB-assisted techniques promise to expand the capabilities of endoluminal therapies.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80482

Program Number: V075

Presentation Session: Endoscopy Video Session

Presentation Type: Video

121

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