title: Prospective, randomized study of conventional versus HybridKnife endoscopic submucosal dissection methods for the esophagus: an animal study.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) increases en bloc and histologically complete resection rate of neoplastic mucosal tumors but is technically more demanding than EMR. Limited data are available comparing the efficacy and safety of a new ESD designed to overcome these limitations and conventional ESD (C-ESD) techniques.
  
  
  OBJECTIVE
  To compare the safety, efficacy, and operation time of the new HybridKnife ESD (HK-ESD) with C-ESD in the esophagus.
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  Animal research laboratory.
  
  
  METHODS
  Seventeen anesthetized Yorkshire pigs.
  
  
  METHODS
  Removal of a 4-cm length of half-circumference esophageal mucosa by C-ESD with Hook knife or Flexknife versus HK-ESD.
  
  
  METHODS
  Procedure time, en bloc and complete resection rate, and complications (bleeding and perforation).
  
  
  RESULTS
  All resections were completed en bloc. Procedure time was shorter in C-ESD. However, it was similar after 12 procedures. Significantly more bleeding occurred during C-ESD (28 vs 12, P = .0007). Histological muscularis propria injuries occurred with equal frequency (16 vs 17) and were mostly seen during the first 11 procedures. There were 3 perforations (2 endoscopic, 1 histological), all with C-ESD.
  
  
  CONCLUSIONS
  Nonsurvival study, use of 2 conventional knives, no training period for a new procedure.
  
  
  CONCLUSIONS
  The HK-ESD technique was equally effective as the C-ESD technique for successful en bloc resection and was safer with less bleeding and perforation. Although procedure time was longer in HK-ESD, the difference became nonsignificant after 12 procedures.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Denver, Aurora, Colorado 80045-2541, USA.
authors.forename: Norio
authors.initials: N
authors.lastname: Fukami
authors.forename: Chang Beom
authors.initials: CB
authors.lastname: Ryu
authors.forename: Sherif
authors.initials: S
authors.lastname: Said
authors.forename: Zachary
authors.initials: Z
authors.lastname: Weber
authors.forename: Yang K
authors.initials: YK
authors.lastname: Chen
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical; D004210:Dissection / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004598:Electrosurgery / Q000295:instrumentation*; D004939:Esophageal Perforation / Q000209:etiology; D004945:Esophagoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004947:Esophagus / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D009092:Mucous Membrane / Q000473:pathology / Q000601:surgery*; D009130:Muscle, Smooth / Q000293:injuries; D013552:Swine; D013997:Time Factors