Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country.
BACKGROUND
Endoscopic submucosal dissection (ESD) is an effective but time-consuming treatment for early neoplasia that requires a high level of expertise.


OBJECTIVE
The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with high pressure water jet and to compare with standard ESD.


METHODS
We performed a prospective non survival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard).


RESULTS
Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0 (hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04). Hybrid-knife ESD was faster than standard (time: 44.6 +/- 21.4 minutes vs. 68.7 +/- 33.5 minutes; p = 0.009 and velocity: 20.8 +/- 9.2 mm(2)/min vs. 14.3 +/- 9.3 mm(2)/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 +/- 15.68 to 28.18 +/- 20.07 mm(2)/min; p = 0.615 and standard: From 6.4 +/- 0.3 to 19.48 +/- 19.21 mm(2)/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %).


CONCLUSIONS
despite the initial performance of hybrid-knife ESD is worse than standard ESD, the learning curve with hybrid knife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.
Joaquín
J
De-la-Peña
Ángel
Á
Calderón
José Miguel
JM
Esteban
Leopoldo
L
López-Rosés
David
D
Martínez-Ares
Óscar
Ó
Nogales
Aitor
A
Orive-Calzada
Sarbelio
S
Rodríguez
Eloy
E
Sánchez-Hernández
Juan
J
Vila
Gloria
G
Fernández-Esparrach
D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D059032:Learning Curve; D008297:Male; D013274:Stomach Neoplasms / Q000601:surgery*; D013525:Surgical Instruments; D013552:Swine