title: Esophageal Endoscopic Submucosal Dissection Assisted by an Overtube with a Traction Forceps: An Animal Study.
abstract: Esophageal endoscopic submucosal dissection (ESD) is technically difficult. To make it safer, we developed a novel method using overtube with a traction forceps (OTF) for countertraction during submucosal dissection. We conducted an ex vivo animal study and compared the clinical outcomes between OTF-ESD and conventional method (C-ESD). A total of 32 esophageal ESD procedures were performed by four beginner and expert endoscopists. After circumferential mucosal incision for the target lesion, structured as the isolated pig esophagus 3 cm long, either C-ESD or OTF-ESD was randomly selected for submucosal dissection. All the ESD procedures were completed as en bloc resections, while perforation only occurred in a beginner's C-ESD procedure. The dissection time for OTF-ESD was significantly shorter than that for C-ESD for both the beginner and expert endoscopists (22.8 ± 8.3 min versus 7.8 ± 4.5 min, P < 0.001, and 11.3 ± 4.4 min versus 5.9 ± 2.5 min, P = 0.01, resp.). The frequency and volume of the submucosal injections were significantly smaller for OTF-ESD than for C-ESD (1.3 ± 0.6 times versus 2.9 ± 1.5 times, P < 0.001, and 5.3 ± 2.8 mL versus 15.6 ± 7.3 mL, P < 0.001, resp.). Histologically, muscular injury was more common among the C-ESD procedures (80% versus 13%, P = 0.009). Our results indicated that the OTF-ESD technique is useful for the safe and easy completion of esophageal ESD.
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Ken
authors.identifier: 0000-0003-0288-0366
authors.initials: K
authors.lastname: Ohata
authors.affiliation: Department of Endoscopy, Kanma Memorial Hospital, Nasushiobara 325-0046, Japan.
authors.forename: Kuangi
authors.initials: K
authors.lastname: Fu
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Sakai
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Kouichi
authors.identifier: 0000-0003-2791-4462
authors.initials: K
authors.lastname: Nonaka
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Tashima
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Minato
authors.affiliation: Department of Gastroenterology, Kyorin University School of Medicine, Tokyo 181-8611, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ohno
authors.affiliation: Department of Gastroenterology, Keiyu Hospital, Yokohama 220-0012, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ito
authors.affiliation: Department of Gastroenterology, University of Tokyo, Tokyo 113-8655, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuji
authors.affiliation: Department of Gastroenterology, Omori Red Cross Hospital, Tokyo 143-8527, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Chiba
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Yokkaichi Municipal Hospital, Yokkaichi 510-0822, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamawaki
authors.affiliation: Department of Gastroenterology, Moriguchi Keijinkai Hospital, Osaka 570-0021, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Hemmi
authors.affiliation: Department of Gastroenterology, Yamaga Chuo Hospital, Yamaga 861-0501, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Nakaya
authors.affiliation: Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Fukushima
authors.affiliation: Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo 141-8625, Japan.
authors.forename: Nobuyuki
authors.identifier: 0000-0002-0139-430X
authors.initials: N
authors.lastname: Matsuhashi