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, 7 (5), E641-E646

Endoscopic Submucosal Dissection With a Novel High Viscosity Injection Solution (LiftUp) in an Ex Vivo Model: A Prospective Randomized Study

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Endoscopic Submucosal Dissection With a Novel High Viscosity Injection Solution (LiftUp) in an Ex Vivo Model: A Prospective Randomized Study

E Wedi et al. Endosc Int Open.

Abstract

Introduction Endoscopic submucosal dissection (ESD) is increasingly being used in the western world. Submucosal injectates are an essential tool for the ESD procedure. In this study, we evaluated a novel copolymer injectate (LiftUp, Ovesco, Tübingen Germany) in an established ESD model (EASIE-R) in comparison to existing submucosal injectables. Materials and methods We conducted a prospective, randomized ex vivo study performing ESD with three injectates: LiftUp, hydroxyethyl starch (HAES 6 %) and normal saline solution (NaCl 0.9 %). A total of 60 artificial lesions, each 3 × 3 cm in size, were resected in an ex vivo porcine model, utilizing one of the three studied injectates (n = 20 ESDs per injectate). Study parameters were: en bloc resection rate, perforation rate, lifting property, time of injection, injectate volume, general ESD procedure time, and overall procedure time. Results All 60 lesions were successfully resected using the standard ESD technique. LiftUp had no procedure related perforations, one perforation occurred in the HAES group, and two perforations in the NaCl group ( P > 0.05). Furthermore, adequate lifting was achieved in 16/20 (80 %) using LiftUp, 6/20 (30 %) in the HAES group and 6/20 (30 %) in the NaCl group ( P < 0.0002). En bloc resection was achieved in 19 (95 %) with LiftUp, in 20 (100 %) with HAES, and in 16 (80 %) with NaCl. General ESD procedure time and overall procedure time were not different among the three groups. Conclusion LiftUp appears to be a safe alternative to established fluids for ESD. It had a significantly improved lifting effect and required significantly less injected volume compared to well-established lifting solutions.

Conflict of interest statement

Competing interests Peter Koehler, Jürgen Hochberger, Jürgen Maiss, Sini Milenovic, Mark Gromski, Ulrich Baulain, Carlo Jung and Volker Ellenrieder have no conflicts of interest or financial ties to disclose. Edris Wedi received material support for research and lecture fees from Ovesco Endoscopy AG. Chi-Nghia Ho and Conrad Gabor declare that they hold management positions with Ovesco Endoscopy AG.

Figures

Fig. 1
Fig. 1
EASIE-R simulator for ESD procedures. The porcine stomach is thawed before the procedure and placed in the EASIE-R simulator. A water bath at 37 °C was used to simulate the in vivo environment and keep the porcine stomach homothermal.
Fig. 2
Fig. 2
Standardized lesions to be resected by ESD were manually placed in the corpus of porcine stomach, each measuring 3 × 3 cm.
Fig. 3
Fig. 3
Steps in the ESD procedure with LiftUp.  a Submucosal cushion after LiftUp injection. b – d Submucosal dissection with a FlushKnife. The submucosal cushion remains stable with LiftUp during the entire procedure. The specimen was spread and pinned on a cork mat after the ESD procedure.
Fig. 4
Fig. 4
Lifting persistency under simulation circumstances in the porcine model for HAES 6 %, LiftUp, and NaCl 0.9 %.
Fig. 5
Fig. 5
Injection volume (mL) dependent on the injection substance (mL).
Fig. 6
Fig. 6
ESD procedure time (minutes) dependent on the injection substance.

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References

    1. Wang J, Zhang X H, Ge J et al. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis. World J Gastroenterol. 2014;20:8282–8287. - PMC - PubMed
    1. Hochberger J, Koehler P, Kruse E et al. Endoscopic submucosal dissection. Der Internist. 2013;54:287–301. - PubMed
    1. Oka S, Tanaka S, Kaneko I et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64:877–883. - PubMed
    1. Nakamoto S, Sakai Y, Kasanuki J et al. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan: a comparative study with endoscopic submucosal dissection. Endoscopy. 2009;41:746–750. - PubMed
    1. Tamegai Y, Saito Y, Masaki N et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy. 2007;39:418–422. - PubMed
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