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Ex vivo comparative study using the Endolifter® as a traction device for enhancing submucosal visualization during endoscopic submucosal dissection

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Abstract

Background

Endoscopic submucosal dissection (ESD) is a technically demanding procedure, and exposure of the submucosa depends on the action of gravity and submucosal injection. The aim of the study was to investigate the effectiveness of the Endolifter® as a traction device for enhancing submucosal visualization during ESD.

Methods

This was a prospective ex vivo comparative study conducted between September 2010 and March 2011 in the Prince of Wales Hospital. Consecutive ESDs were performed by four experienced endoscopists in an ex vivo ESD model with or without the Endolifter®. The Endolifter® allows simultaneous grasping, retracting and lifting of the mucosa during ESD, resulting in exposure of the submucosa. Each of the procedures were recorded and reviewed later by two independent assessors. The outcome measures included the proportion of time that the submucosa was visualized during the procedures (SM ratio), procedural times, perforation rates, amount of submucosal injections, and the difficulty of the procedure.

Results

Forty-eight gastric ESD procedures were performed on the model. The SM ratio was higher in the Endolifter® group (P = 0.007), particularly for lesions located at the antrum (P < 0.001). The time required for submucosal dissection and the total procedural time were also less in the Endolifter® group. The endoscopists rated the ESD procedures in the Endolifter® group as less difficult (P = 0.033).

Conclusions

The Endolifter® improved submucosal visualization during gastric ESD and reduces the difficulty of performing the procedures. The device may improve the ease of performing ESD in low-volume centers or large mucosal lesions.

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Acknowledgments

We thank Candice Lam, Bonnie Tsung, Wong Mei Yin, and Leung Siu Fung for their assistance during the conduct of the study.

Disclosures

Drs. Anthony Yuen Bun Teoh, Philip Wai Yan Chiu, So Fei Hon, Tony Wing Chung Mak, Enders Kwok Wai Ng and James Yun Wong Lau have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Anthony Yuen Bun Teoh.

Electronic supplementary material

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Video 1 Video showing the one-stop action of the Endolifter® in exposing the submucosa, enhancing the performance of ESD

Video 1 Video showing the one-stop action of the Endolifter® in exposing the submucosa, enhancing the performance of ESD

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Teoh, A.Y.B., Chiu, P.W.Y., Hon, S.F. et al. Ex vivo comparative study using the Endolifter® as a traction device for enhancing submucosal visualization during endoscopic submucosal dissection. Surg Endosc 27, 1422–1427 (2013) doi:10.1007/s00464-012-2583-y

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Keywords

  • Endolifter
  • Endoscopic mucosal resection
  • Endoscopic submucosal dissection
  • Gastric mucosa/surgery
  • Stomach neoplasms/surgery
  • Surgical procedures—minimally invasive/methods