title: Water-jet dissector for endoscopic submucosal dissection in an animal study: outcomes of the continuous and pulsed modes.
abstract: BACKGROUND
  Endoscopic submucosal dissection (ESD) allows en bloc resection of early neoplastic lesions of gastrointestinal tract. Lesions are lifted by submucosal fluid injection before circumferential incision and dissection. High-pressure fluid injection using water jet (WJ) technology is already used for lifting and dissection in surgery. The study was designed to assess WJ for ESD submucosal lifting and dissection.
  
  
  METHODS
  An experimental, randomized comparative, "in vivo" nonsurvival animal study on 12 pigs was designed. Stomach mucosal areas were delineated and resected using three ESD techniques: technique A-syringe injection and IT knife dissection; technique B-WJ continuous injection and IT knife dissection; technique C-WJ injection and WJ pulsed dissection. Injection and dissection speeds and complications rates were assessed.
  
  
  RESULTS
  Water jet continuous injection is faster than syringe injection (B faster than A, p = 0.001 and B nonsignificantly faster than C, p = 0.06). IT knife dissection is significantly faster after WJ continuous injection (B faster than A, p = 0.003). WJ pulsed dissection is significantly slower than IT knife dissection (C slower than A and B, both p < 0.001). The overall procedure speed was significantly higher and the immediate bleedings rate was significantly lower for technique B than A and C (overall procedure speed p = 0.001, immediate bleedings p = 0.032 and 0.038 respectively). There were no perforations with any technique.
  
  
  CONCLUSIONS
  Water jet fluid continuous injection speeds up ESD, whereas pulsed WJ dissection does not.
authors.affiliation: Digestive Disease Department, "Edouard Herriot" Hospital, 5 Place d'Arsonval, 69437 Lyon Cedex 03, Lyon, France. vincent.lepilliez@chu-lyon.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Lepilliez
authors.forename: Carlos
authors.initials: C
authors.lastname: Robles-Medranda
authors.forename: Mihai
authors.initials: M
authors.lastname: Ciocirlan
authors.forename: Hannah
authors.initials: H
authors.lastname: Lukashok
authors.forename: Marwan
authors.initials: M
authors.lastname: Chemali
authors.forename: Stephan
authors.initials: S
authors.lastname: Langonnet
authors.forename: Sabrina
authors.initials: S
authors.lastname: Chesnais
authors.forename: Valerie
authors.initials: V
authors.lastname: Hervieu
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004210:Dissection / Q000379:methods*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005753:Gastric Mucosa / Q000601:surgery*; D009374:Neoplasms, Experimental / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery*; D013552:Swine; D014867:Water
chemical_list: D014867:Water