Published online Jun 27, 2021. doi: 10.4240/wjgs.v13.i6.563
Peer-review started: February 9, 2021
First decision: May 4, 2021
Revised: May 7, 2021
Accepted: June 16, 2021
Article in press: June 16, 2021
Published online: June 27, 2021
Processing time: 129 Days and 4.2 Hours
Hybrid endoscopic submucosal dissection (ESD) that comprises mucosal incision and partial submucosal dissection followed by snaring in a planned manner, has been developed for endoscopic resection of gastrointestinal neoplasms to overcome the technical barrier of ESD. Although the superiority of hybrid ESD with SOUTEN, a single multifunctional device, over conventional ESD has been indicated, the actual effect of snaring itself remains unclear since SOUTEN could be applied to hybrid ESD group, but not to the conventional ESD group, due to ethical issue in clinical practice.
To determine whether and how hybrid ESD was superior to conventional ESD in the endoscopic treatment of gastric lesions in an ex vivo porcine model basic study.
Sixteen endoscopists participated in this basic study in August 2020 at Kyushu University, performing 32 procedures each for hybrid ESD and conventional ESD. Mock lesions (10-15 mm, diameter) were created in the porcine stomach. The primary outcome was total procedure time and secondary outcomes were en bloc or complete resection, perforation, procedure time/speed for both, mucosal incision, and submucosal dissection. Factors associated with difficulty in ESD including longer procedure time, incomplete resection, and perforation, were also investigated. Categorical and continuous data were analyzed using the chi-square test or Fisher’s exact test and the Mann-Whitney U test, respectively.
The median total procedure time of hybrid ESD was significantly shorter than that of conventional ESD (median: 8.3 min vs 16.2 min, P < 0.001). Time, speed, and the amount of hyaluronic acid during submucosal dissection were more favorable in hybrid ESD than conventional ESD (time, 5.2 min vs 10.4 min, P < 0.001; speed, 43.7 mm2/min vs 23.8 mm2/min, P < 0.00; injection volume, 1.5 mL vs 3.0 mL, P < 0.001), although no significant differences in those factors were observed between both groups during mucosal incision. There was also no significant difference between both groups in the en bloc/complete resection rate and perforation rate (complete resection, 93.8% vs 87.5%, P = 0.67; perforation, 0% vs 3.1%, P = 1). Selection of conventional ESD as the treatment method was significantly associated with difficulties during ESD (odds ratio = 10.2; highest among factors).
Hybrid ESD with SOUTEN improves the treatment outcomes of gastric lesions. It also has the potential to reduce medical costs since SOUTEN is a single multifunctional device that is inexpensive.
Core Tip: Hybrid endoscopic submucosal dissection (ESD) is an intermediate technique between endoscopic mucosal resection (EMR) and ESD, which has been developed to overcome the curative barrier of EMR and the technical barrier of ESD in treating gastrointestinal neoplasms. We conducted an ex vivo porcine model basic study to determine the superiority of hybrid ESD with SOUTEN over conventional ESD in treating gastric lesions. The 32 outcomes of each hybrid ESD and conventional ESD were compared. Hybrid ESD had a significantly shorter total procedure time, favorable curability, and low complication rates, compared to conventional ESD. Hybrid ESD with SOUTEN could reduce the costs of ESD.