Esophageal Endoscopic Submucosal Dissection Assisted by an Overtube with a Traction Forceps: An Animal Study

Abstract EN

Esophageal endoscopic submucosal dissection (ESD) is technically difficult.

To make it safer, we developed a novel method using overtube with a traction forceps (OTF) for countertraction during submucosal dissection.

We conducted an ex vivo animal study and compared the clinical outcomes between OTF-ESD and conventional method (C-ESD).

A total of 32 esophageal ESD procedures were performed by four beginner and expert endoscopists.

After circumferential mucosal incision for the target lesion, structured as the isolated pig esophagus 3 cm long, either C-ESD or OTF-ESD was randomly selected for submucosal dissection.

All the ESD procedures were completed as en bloc resections, while perforation only occurred in a beginner’s C-ESD procedure.

The dissection time for OTF-ESD was significantly shorter than that for C-ESD for both the beginner and expert endoscopists ( 22.8 ± 8.3 min versus 7.8 ± 4.5 min, P < 0.001 , and 11.3 ± 4.4 min versus 5.9 ± 2.5 min, P = 0.01 , resp.).

The frequency and volume of the submucosal injections were significantly smaller for OTF-ESD than for C-ESD ( 1.3 ± 0.6 times versus 2.9 ± 1.5 times, P < 0.001 , and 5.3 ± 2.8 mL versus 15.6 ± 7.3 mL, P < 0.001 , resp.).

Histologically, muscular injury was more common among the C-ESD procedures (80% versus 13%, P = 0.009 ).

Our results indicated that the OTF-ESD technique is useful for the safe and easy completion of esophageal ESD.