Gastric endoscopic submucosal dissection under steady pressure automatically controlled endoscopy (SPACE); a multicenter randomized preclinical trial
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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.
KeywordsSPACE ESD Early gastric cancer GI Endoscopy Technical
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 1 (WMV 22,400 kb)
- 3.von Delius S, Huber W, Feussner H, Wilhelm D, Karagianni A, Henke J, Preissel A, Schneider A, Schmid RM, Meining A (2007) Effect of pneumoperitoneum on hemodynamics and inspiratory pressures during natural orifice transluminal endoscopic surgery (NOTES): an experimental, controlled study in an acute porcine model. Endoscopy 39:854–861CrossRefGoogle Scholar
- 5.Navarro-Ripoll R, Martinez-Palli G, Guarner-Argente C, Cordova H, Martinez-Zamora MA, Comas J, de Miguel CR, Beltran M, Rodriguez-D’Jesus A, Hernandez-Cera C, Llach J, Balust J, Fernandez-Esparrach G (2012) On-demand endoscopic CO2 insufflation with feedback pressure regulation during natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy induces minimal hemodynamic and respiratory changes. Gastrointest Endosc 76:388–395CrossRefPubMedGoogle Scholar
- 6.Nakajima K, Moon JH, Tsutsui S, Miyazaki Y, Yamasaki M, Yamada T, Kato M, Yasuda K, Sumiyama K, Yahagi N, Saida Y, Kondo H, Nishida T, Mori M, Doki Y (2012) Esophageal submucosal dissection under steady pressure automatically controlled endoscopy (SPACE): a randomized preclinical trial. Endoscopy 44:1139–1148CrossRefPubMedGoogle Scholar
- 7.Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235CrossRefPubMedGoogle Scholar