title: Thulium laser in interventional endoscopy: animal and human studies.
abstract: Background and study aimsThe thulium laser system (TLS) is an emerging surgical tool. The 2-μm wavelength provides a confined coagulation depth (0.2 - 0.4 mm) to reduce the potential for inadvertent injuries. For the first time ever, we assessed TLS feasibility for endoscopic hemostasis ex vivo in pigs. In addition, we performed the first in vivo hemostatic treatments in humans.Patients and methodsTissue damage induced by TLS using different settings and optical fibers was compared to that from argon plasma coagulation (APC) in established ex vivo animal models. Three consecutive patients with complex nonvariceal upper gastrointestinal bleedings were treated and followed up.ResultsNo deep submucosal injury was observed in animal models. The TLS showed a progressive penetration depth with increased power outputs and tissue exposures but very limited vertical tissue injury (0.1 - 2.0 mm) and lateral spreading damage (0.1 - 0.3 mm and 0.2 - 0.7 mm using the 365-µm and 550-µm fibers, respectively). In vivo, endoscopic hemostasis with TLS was always successful without complications.ConclusionsThe TLS has proven to be very precise and easy to use. This novel technique appears to be a promising tool for advanced interventional endoscopy.
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Gian E
authors.initials: GE
authors.lastname: Tontini
authors.affiliation: Interventional Endoscopy Center, University Hospital Mainz, Mainz, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Neumann
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pastorelli
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Spina
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Flaminia
authors.initials: F
authors.lastname: Cavallaro
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Soriani
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rimondi
authors.affiliation: Pathology and Cytodiagnostic Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bruni
authors.affiliation: Pathology and Cytodiagnostic Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Clemente
authors.affiliation: Surgical Division, Quanta System S.p.A., Varese, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Fagnani
authors.affiliation: Division of General Surgery I, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Lagoussis
authors.affiliation: Academic Urology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Carmignani
authors.affiliation: Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vecchi
mesh_terms: D000368:Aged; D000818:Animals; D057908:Argon Plasma Coagulation; D004381:Duodenal Ulcer / Q000150:complications; D016145:Endoscopy, Digestive System; D005240:Feasibility Studies; D020252:Gastric Antral Vascular Ectasia / Q000150:complications / Q000628:therapy; D005753:Gastric Mucosa; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation; D053844:Lasers, Solid-State / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000150:complications* / Q000473:pathology; D013552:Swine; D013932:Thulium
chemical_list: D013932:Thulium