Enhancement of the safety and efficacy of colorectal endoscopic submucosal dissection using a CO2 laser
- 23 Downloads
Endoscopic submucosal dissection (ESD) has been at the forefront of international attention as a less invasive treatment for early gastrointestinal cancer. Currently, ESD involves the use of an electrosurgical knife for mucosal incision and subsequent submucosal dissection. However, it has been reported that perforation occurs in approximately 5% of cases. To enhance tissue selectivity with this modality, we focused on applying a laser to ESD (laser ESD). A CO2 laser was chosen as the surgical knife because the saline or sodium hyaluronate solution injected into the submucosal layer during the current ESD procedure has a high absorption coefficient at the wavelength of the CO2 laser. Thus, the purpose of this study is to quantitatively clarify the safety and efficacy of laser ESD for the colon. First, we validated a porcine colon as a model of the human colon in terms of optical and thermal properties. Next, ex vivo experiments on the safety and efficacy of laser ESD were performed. In ex vivo experiments using extracted porcine colon tissue, an incision depth of 0.5–1.0 mm was obtained without thermal damage to the muscle layer when the power density was set at 17, 22, or 28 W/mm2. In addition, less thermal damage was observed in tissue incised with this method compared with electrosurgical knives. These results might be explained by the strong absorption of the CO2 laser by the saline injected into the submucosa. Therefore, laser ESD is expected to be a safer method for the treatment of early colon cancer.
KeywordsCarbon dioxide laser Colon cancer Endoscopic submucosal dissection Laser absorber Perforation Thermal damage
The authors would like to thank J. Morita Mfg. Corp. for technical support with the CO2 laser device and the hollow optical fiber. The authors gratefully acknowledge Tsunekazu Mizushima, Hirofumi Yamamoto, and Koki Takeda of the Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, for their cooperation in obtaining human colon samples and Hiroaki Muta of the Graduate School of Engineering, Osaka University, for his cooperation on the experiment using the confocal laser scanning microscope.
This research was supported by a Development of Medical Devices grant through the Collaboration between Medicine and Industry from the Japan Agency for Medical Research and Development (Grant number 27-008).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by the Ethics Review Committee of the Osaka University Hospital (Approval Number: T17109) and conducted in accordance with the institutional guidelines for ethics regarding medical research targeting humans.
Informed consent was obtained from all individual participants included in this study.
- 2.Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endosc 39:418–422. https://doi.org/10.1055/s-2007-966427
- 3.Fuccio L, Hassan C, Ponchon D, Farioli A, Cucchetti A, Frazzoni L, Bhandari P, Bellisario C, Bazzoli F, Repici A (2017) Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 86:74–86. https://doi.org/10.1016/j.gie.2017.02.024 CrossRefGoogle Scholar
- 8.Toyota T, Morita Y, Azuma T (2009) The knack for colorectal ESD. Gastroterol Endosc 51:2480–2497Google Scholar
- 9.Hayashi N, Tanaka S, Nishiyama S, Terasaki M, Nakadoi K, Oka S, Yoshihara M, Chayama K (2014) Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc 79:427–435. https://doi.org/10.1016/j.gie.2013.09.014 CrossRefGoogle Scholar
- 10.Mizushima T, Kato M, Iwanaga I, Sato F, Kubo K, Ehira N, Uebayashi M, Ono S, Nakagawa M, Mabe K, Shimizu Y, Sakamoto N (2015) Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc 29:133–139. https://doi.org/10.1007/s00464-014-3665-9 CrossRefGoogle Scholar
- 11.Jung D, Youn YH, Jahng J, Kim JH, Park H (2013) Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Endosc 45:714–717. https://doi.org/10.1055/s-0033-1344555