title: The Efficacy of an Endoscopic Grasp-and-Traction Device for Gastric Endoscopic Submucosal Dissection: An Ex Vivo Comparative Study (with Video).
abstract: OBJECTIVE
  To investigate whether the EndoLifter (Olympus), a counter-traction device facilitating submucosal dissection, can accelerate endoscopic submucosal dissection (ESD).
  
  
  METHODS
  Two endoscopists (novice/expert in ESD) performed 64 ESDs (artificial 3-cm lesions) in 16 ex vivo pig stomachs: per stomach, two at the posterior wall (forward approach) and two at the lesser curvature (retroflex approach). Per approach, one lesion was dissected with (EL+) and one without (EL-) the EndoLifter. The submucosal dissection time (SDT), corrected for specimen size, and the influence of ESD experience on EndoLifter usefulness were assessed.
  
  
  RESULTS
  En bloc resection rate was 98.4%. In the forward approach, the median SDT was shorter with the EndoLifter (0.56 min/cm(2) vs. 0.91 min/cm(2)), although not significantly (p=0.09). The ESD-experienced endoscopist benefitted more from the EndoLifter (0.45 [EL+] min/cm(2) vs. 0.68 [EL-] min/cm(2), p=0.07) than the ESD-inexperienced endoscopist (0.77 [EL+] min/cm(2) vs. 1.01 [EL-] min/cm(2), p=0.48). In the retroflex approach, the median SDTs were 1.06 (EL+) and 0.48 (EL-) min/cm(2) (p=0.16). The EndoLifter did not shorten the SDT for the ESD-experienced endoscopist (0.68 [EL+] min/cm(2) vs. 0.68 [EL-] min/cm(2), p=0.78), whereas the ESD-inexperienced endoscopist seemed hindered (1.65 [EL+] min/cm(2) vs. 0.38 [EL-] min/cm(2), p=0.03).
  
  
  CONCLUSIONS
  In gastric ESD, the EndoLifter, in trend, shortens SDTs in the forward, but not in the retroflex approach. Given the low numbers in this study, a type II error cannot be excluded.
authors.affiliation: Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands. ; Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Dirk W
authors.initials: DW
authors.lastname: Schölvinck
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. ; Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Goto
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jacques J G H M
authors.initials: JJ
authors.lastname: Bergman
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands. ; Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Bas L A M
authors.initials: BL
authors.lastname: Weusten
keywords: EndoLifter; Endoscopic submucosal dissection; Gastric mucosa; Stomach neoplasms; Swine