Randomized controlled trial comparing Submucosal Endoscopy with Mucosal Resection (SEMR) and Endoscopic submucosal dissection (ESD) in the Esophagus and Stomach: An animal study

Abstract

Objectives

In Western countries ESD (Endoscopic Submucosal Dissection) has not prevailed due to training issues and a target patient population. We reported a hybrid ESD technique, SEMR (submucosal endoscopy with mucosal resection), in which the submucosal dissection is performed chiefly by blunt balloon dissection. We have reported successful application in the porcine colon. In this study we compared the safety and efficacy between SEMR with ESD in the porcine esophagus and stomach.

Methods

SEMR and ESD were performed in 8 domestic pigs under general anesthesia. Resection sites were marked by circumferential coagulation. After circumferential ESD knife mucosal incision, submucosal fluid cushion (SFC) was created. In the SEMR group, the balloon catheter was inserted deep into the SFC. The balloon was then inflated and pulled back toward the endoscope tip repeatedly, altering the direction, to disrupt the submucosa. Residual strands were cut with IT-knife. En-bloc resection rates, procedure times, complications and dissection difficulty scales (DDS) were recorded prospectively. DDS were rated using a visual analog scale.

Results

32 resections (8 SEMR/ 8 ESD in the esophagus; 8 SEMR/ 8 ESD in the stomach) were performed with no major adverse events. There was no statistical difference between the two techniques in either location in the above categories measured.

Conclusions

SEMR and traditional ESD are comparable techniques in safety and effectiveness when performed in the esophagus and stomach. SEMR may serve as a more appealing technical option for endoscopists who are unable to sustain a traditional ESD practice volume.

This article is protected by copyright. All rights reserved.

http://ift.tt/2s8w7Av