title: Gastric endoscopic submucosal dissection under steady pressure automatically controlled endoscopy (SPACE); a multicenter randomized preclinical trial.
abstract: BACKGROUND
  Steady pressure automatically controlled endoscopy (SPACE) is a new modality that eliminates on-demand insufflation but enables automatic insufflation in the gastrointestinal tract. Though its use in porcine esophageal ESD was reported to be promising, its applicability and potential effectiveness to gastric procedures have not been evaluated.
  
  
  OBJECTIVE
  The aims were (1) to evaluate feasibility and safety of SPACE in the stomach, and (2) to assess its potential advantages over conventional endoscopy in preventing "blind insufflation"-related complications.
  
  
  METHODS
  A multicenter randomized preclinical animal study.
  
  
  METHODS
  Laboratories at three universities.
  
  
  METHODS
  Experiment 1: Gastric ESD was attempted in the swine (n = 17), under either SPACE or manual insufflation. Experiment 2: Gastroscopy was performed for 10 min in the perforated stomach (n = 10) under either SPACE or manual insufflation.
  
  
  METHODS
  Experiment 1: ESD time, energy device activation time, number of forceps exchanges, specimen size, en block resection rate, vital signs and any intraoperative adverse events. Experiment 2: Intra-gastric and intra-abdominal pressures, vital signs, and any adverse events.
  
  
  RESULTS
  Experiment 1: Gastric ESD was completed in all animals. ESD time tended to be shorter in SPACE than in the control, though the difference was not significant (p = 0.18). Experiment 2: Although both intra-gastric and intra-abdominal pressures remained within preset values in SPACE, they showed excessive elevation in control.
  
  
  CONCLUSIONS
  An animal study with small sample size.
  
  
  CONCLUSIONS
  SPACE is feasible and safe for complicated and lengthy procedures such as gastric ESD, and is potentially effective in preventing serious consequences related to excessive blind insufflation.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, Osaka, Japan, yamtak@gh.med.osaka-u.ac.jp.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamada
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirota
authors.forename: Shusaku
authors.initials: S
authors.lastname: Tsutsui
authors.forename: Motohiko
authors.initials: M
authors.lastname: Kato
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yasuda
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tsujii
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Takehara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004210:Dissection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000295:instrumentation / Q000379:methods*; D007327:Insufflation / Q000379:methods*; D011312:Pressure; D013274:Stomach Neoplasms / Q000601:surgery*; D013552:Swine