title: High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience.
abstract: BACKGROUND
  Long lasting elevation is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water jet injection of saline solution or by viscous macromolecular solutions. In a previous animal study, we assessed the Nestis Enki II system to combine jet injection and viscous solutions. In the present work, we used this combination in humans in different sites of the digestive tract.
  
  
  METHODS
  We retrospectively report all of the consecutive ESD procedures performed with jet injection of viscous solutions in four centers. Information was collected about the lesion, the procedure, the histological result, and the outcomes for the patient.
  
  
  RESULTS
  In total, 45 resections were completed by six operators: five experts and one beginner with only one previous experience in human ESD. Lesions were located in the esophagus (10), the stomach (11), the duodenum (1), the colon (1) and the rectum (22). Average maximal lesion diameter was 4.8 cm (SD 2.4, range 2 - 11 cm), average lesion surface area was 19.8 cm(2) (SD 17.7, range 2.2 - 72 cm(2)), and average duration of procedure was 79.9 min (SD 50.3 min, range 19 - 225 min). ESD could be conducted while the endoscope was retroflexed at its maximum in 26 cases. Four adverse events were observed: two diminutive perforations and two delayed bleeding occurrences treated conservatively. The R0 resection rate was 91.1 %. The catheter was obstructed in six occurrences of bleeding.
  
  
  CONCLUSIONS
  Endoscopic submucosal dissection using high pressure injection of viscous macromolecular solutions is safe and effective in different parts of the digestive tract. It does not impede working with the endoscope in the maximal retroflexed position.
authors.affiliation: Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France ; Nestis Clinical Research, Lyon, France ; Inserm U1032, LabTau, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Pioche
authors.affiliation: Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France ; Digestive Disease Department, Hôpital Privé Jean Mermoz, Lyon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Lépilliez
authors.affiliation: Digestive Disease Department, St-Luc Hospital, Louvain, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Déprez
authors.affiliation: Digestive Disease Department, Institut Paoli Calmette, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.affiliation: Digestive Disease Department, Institut Paoli Calmette, Marseille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.affiliation: Digestive Disease Department, St-Luc Hospital, Louvain, Belgium.
authors.forename: Hubert
authors.initials: H
authors.lastname: Piessevaux
authors.affiliation: Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rivory
authors.affiliation: Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.affiliation: Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France ; Carol Davila University of Medicine and Pharmacy, Fundeni Gastroenterology Clinic, Bucharest, Romania.
authors.forename: Mihai
authors.initials: M
authors.lastname: Ciocîrlan
authors.affiliation: Pharmacy, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Salmon
authors.affiliation: Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Lienhart
authors.affiliation: Inserm U1032, LabTau, Lyon, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Lafon
authors.affiliation: Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Saurin
authors.affiliation: Digestive Disease Department, Hôpital Edouard Herriot, Lyon, France ; Inserm U1032, LabTau, Lyon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon