Brief Article
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World J Gastrointest Endosc. Jun 16, 2013; 5(6): 275-280
Published online Jun 16, 2013. doi: 10.4253/wjge.v5.i6.275
Effectiveness of circumferential endoscopic mucosal resection with a novel tissue-anchoring device
Yunho Jung, Masayuki Kato, Jongchan Lee, Mark A Gromski, Ram Chuttani, Kai Matthes
Yunho Jung, Masayuki Kato, Jongchan Lee, Mark A Gromski, Ram Chuttani, Kai Matthes, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
Author contributions: Jung Y and Kato M contributed equally to this work; Jung Y, Kato M, Lee J, Gromski MA, Chuttani R and Matthes K contributed to study design, acquisition of data, analysis and interpretation of data; Jung Y contributed to drafting the article; Gromski MA and Matthes K contributed to revising article critically for important intellectual content; Matthes K gave final approval of the version to be published.
Correspondence to: Kai Matthes, MD, PhD, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Dana 501, Boston, MA 02215, United States. kmatthes@bidmc.harvard.edu
Telephone: +1-617-9017613 Fax: +1-978-4150091
Received: December 12, 2012
Revised: April 10, 2013
Accepted: April 18, 2013
Published online: June 16, 2013
Processing time: 179 Days and 10 Hours
Abstract

AIM: To evaluate the efficacy of circumferential endoscopic mucosal resection (EMR) with a tissue-anchoring device in comparison to forceps precut EMR and conventional endoscopic submucosal dissection (ESD).

METHODS: The study was designed as a prospective, randomized, ex vivo study. Fresh ex vivo specimens were harvested from adult white Yorkshire pigs weighing 30-50 kg. Seventy-five standardized, artificial lesions measuring 3 cm × 3 cm were created by methylene blue tattoo at the greater curvature in fresh ex vivo stomachs using the EASIE-R simulator platform (Endosim LLC, Berlin, MA, United States). The three advanced endoscopists performed the three resection techniques such as circumferential EMR using the tissue-anchoring device (TA-EMR), forceps precut EMR (FP-EMR), and endoscopic submucosal dissection. The endoscopists and the type of cutting methods were determined randomly by grouped randomized selection. The resection bed was grossly inspected to determine whether the lesion was resected “en-bloc” (defined as no remaining mucosal tattoo remaining on specimen). The resection bed was also probed for evidence of perforation. The procedural time of circumferential resection, submucosal dissection, and injection frequency were recorded by an independent observer.

RESULTS: All 75 created lesions were successfully resected by three advanced endoscopists using the three techniques. The mean ± SD size of resected specimens (long axis) were 39.5 ± 5.6 mm, 36.5 ± 7.3 mm, and 44.6 ± 5.6 mm for TA-EMR, FP-EMR, and ESD respectively. The overall mean dissection time of both the TA-EMR and FP-EMR was significant shorter than ESD (TA-EMR: 5.1 ± 3.3 min, FP-EMR: 3.5 ± 2.0 min vs ESD: 15.8 ± 9.5 min, P < 0.001, P < 0.001). The overall mean total procedure time of both the tissue-anchoring and forceps circumferential EMR was significantly shorter than ESD (TA-EMR: 17.5 ± 6.0 min, FP-EMR: 16.6 ± 6.6 min vs ESD: 28.6 ± 13.9 min, P < 0.001, P < 0.001). The en-bloc resection rate of ESD was 100% (25/25) and the en-bloc resection rate of the TA-EMR (84.0%, 21/25) was higher than for the FP-EMR (60.0%, 15/25), yet not statistically significant (P = 0.18). The perforation rate of each technique was 8.0% (2/25).

CONCLUSION: TA-EMR appears to be quicker than ESD, and there was a trend towards improved en bloc resection rate with the TA-EMR when compared to the FP-EMR.

Keywords: Endoscopic mucosal resection; Endoscopic submucosal dissection; En bloc resection; Perforation

Core tip: The recently introduced tissue anchor device has the capability of deploying three spikes into the tissue that allow a reliable fixation of the tissue and facilitate retraction into snare. We demonstrated the efficacy of circumferential endoscopic mucosal resection (EMR) with a novel tissue-anchoring device in comparison with circumferential EMR using conventional forceps, and endoscopic submucosal dissection.