Surgical Endoscopy

, Volume 29, Issue 9, pp 2748–2755 | Cite as

Gastric endoscopic submucosal dissection under steady pressure automatically controlled endoscopy (SPACE); a multicenter randomized preclinical trial

  • Takuya Yamada
  • Masashi Hirota
  • Shusaku Tsutsui
  • Motohiko Kato
  • Tsuyoshi Takahashi
  • Kazuhiro Yasuda
  • Kazuki Sumiyama
  • Masahiko Tsujii
  • Tetsuo Takehara
  • Masaki Mori
  • Yuichiro Doki
  • Kiyokazu NakajimaEmail author



Steady pressure automatically controlled endoscopy (SPACE) is a new modality that eliminates on-demand insufflation but enables automatic insufflation in the gastrointestinal tract. Though its use in porcine esophageal ESD was reported to be promising, its applicability and potential effectiveness to gastric procedures have not been evaluated.


The aims were (1) to evaluate feasibility and safety of SPACE in the stomach, and (2) to assess its potential advantages over conventional endoscopy in preventing “blind insufflation”-related complications.


A multicenter randomized preclinical animal study.


Laboratories at three universities.


Experiment 1: Gastric ESD was attempted in the swine (n = 17), under either SPACE or manual insufflation. Experiment 2: Gastroscopy was performed for 10 min in the perforated stomach (n = 10) under either SPACE or manual insufflation.

Main outcome measurements

Experiment 1: ESD time, energy device activation time, number of forceps exchanges, specimen size, en block resection rate, vital signs and any intraoperative adverse events. Experiment 2: Intra-gastric and intra-abdominal pressures, vital signs, and any adverse events.


Experiment 1: Gastric ESD was completed in all animals. ESD time tended to be shorter in SPACE than in the control, though the difference was not significant (p = 0.18). Experiment 2: Although both intra-gastric and intra-abdominal pressures remained within preset values in SPACE, they showed excessive elevation in control.


An animal study with small sample size.


SPACE is feasible and safe for complicated and lengthy procedures such as gastric ESD, and is potentially effective in preventing serious consequences related to excessive blind insufflation.


SPACE ESD Early gastric cancer GI Endoscopy Technical 



Carbon dioxide


Endoscopic submucosal dissection


Steady pressure automatically controlled endoscopy


Abdominal compartment syndrome


End-tidal carbon dioxide


Percutaneous oxygen saturation



The co-author Kiyokazu Nakajima has received research funding from Top, Co., Ltd. (Tokyo, Japan) and Fujifilm Corp. (Tokyo, Japan).


Authors Takuya Yamada, Masashi Hirota, Shusaku Tsutsui, Motohiko Kato, Tsuyoshi Takahashi, Kazuhiro Yasuda, Kazuki Sumiyama, Masahiko Tsujii, Tetsuo Takehara, Masaki Mori, Yuichiro Doki and Kiyokazu Nakajima have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 22,400 kb)


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Takuya Yamada
    • 1
  • Masashi Hirota
    • 2
    • 3
  • Shusaku Tsutsui
    • 4
  • Motohiko Kato
    • 1
  • Tsuyoshi Takahashi
    • 3
  • Kazuhiro Yasuda
    • 5
  • Kazuki Sumiyama
    • 6
  • Masahiko Tsujii
    • 1
  • Tetsuo Takehara
    • 1
  • Masaki Mori
    • 3
  • Yuichiro Doki
    • 3
  • Kiyokazu Nakajima
    • 2
    • 3
    Email author
  1. 1.Department of Gastroenterology and Hepatology, Graduate School of MedicineOsaka UniversityOsakaJapan
  2. 2.Division of Collaborative Research for Next Generation Endoscopic Intervention (Project ENGINE), The Center for Advanced Medical Engineering and InformaticsOsaka UniversitySuitaJapan
  3. 3.Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
  4. 4.Department of Gastroenterology and HepatologyItami City HospitalItamiJapan
  5. 5.Department of SurgeryTenshindo Hetsugi HospitalOitaJapan
  6. 6.Department of EndoscopyJikei UniversityMinatoJapan

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