title: The ENKI-2 water-jet system versus Dual Knife for endoscopic submucosal dissection of colorectal lesions: a randomized comparative animal study.
abstract: OBJECTIVE
  The ENKI-2 water-jet system for endoscopic submucosal dissection (ESD) combines submucosal saline pressure injection with dissection. The aim of this study was to compare ENKI-2 with a standard device in terms of procedure time and perforation rate during colorectal ESD.
  
  
  METHODS
  In this randomized comparative study, 10 30-mm-diameter lesions were created in the colon and rectum of 10 healthy adult pigs. The ESD procedure time and perforation rates were recorded for the ENKI-2 system and a standard Dual Knife method. Each pig had half the lesions dissected by ENKI-2 and half dissected by Dual Knife. One experienced and one inexperienced endoscopist took part in the study.
  
  
  RESULTS
  A total of 95 lesions were dissected (47 by ENKI-2 and 48 by Dual Knife). The experienced endoscopist was able to excise comparably sized 30-mm lesions using both techniques. The dissection time was shorter for ENKI-2 (18.9 vs. 25.6 minutes; P = 0.034) and the perforation rate was lower compared with the Dual Knife (one perforation [4 %] vs. nine perforations [36 %]; P = 0.011). The inexperienced endoscopist performed significantly larger dissections using the ENKI-2 (934 ± 405 mm2 vs. 673 ± 312 mm2; P = 0.021) despite pre-marking similarly sized artificial lesions. Multivariate analysis demonstrated that for all lesions the dissection time was significantly longer for lesions in the proximal colon (P = 0.001) and the distal colon (P < 0.0001) and shorter for the experienced operator (P < 0.0001). ENKI-2 shortened the dissection time, but not significantly (P = 0.093).
  
  
  CONCLUSIONS
  In experienced hands, the ENKI-2 system shortens dissection time and reduces the perforation rate. This effect was not statistically significant for an inexperienced operator. Dissection was faster in the rectum than the colon.
authors.affiliation: Hépatogastroentérologie, "Hôpital Edouard" Herriot, Lyon, France.
authors.forename: Mihai
authors.initials: M
authors.lastname: Ciocîrlan
authors.affiliation: Hépatogastroentérologie, "Hôpital Edouard" Herriot, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pioche
authors.affiliation: Hépatogastroentérologie, "Hôpital Edouard" Herriot, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lepilliez
authors.affiliation: NESTIS SAS, Lyon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gonon
authors.affiliation: "Claude Bourgelat" Institute, VetagroSup, Lyon, France.
authors.forename: Roland
authors.initials: R
authors.lastname: Roume
authors.affiliation: "Claude Bourgelat" Institute, VetagroSup, Lyon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Noel
authors.affiliation: NESTIS SAS, Lyon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pinset
authors.affiliation: Hépatogastroentérologie, "Hôpital Edouard" Herriot, Lyon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
mesh_terms: D000818:Animals; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000453:epidemiology / Q000209:etiology; D004210:Dissection / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D007413:Intestinal Mucosa / Q000601:surgery*; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D016014:Linear Models; D061646:Operative Time; D011897:Random Allocation; D012002:Rectal Diseases / Q000453:epidemiology / Q000209:etiology; D012007:Rectum / Q000601:surgery*; D013552:Swine