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Hybrid endoscopic submucosal dissection. Endoscopic appearance of a 10-mm yellowish subepithelial lesion in the middle rectum (a, white light and FICE). After submucosal injection of epinephrine-saline mixture (1: 100,000) and methylene blue with adequate lifting of the entire lesion, a circumferential incision was performed using ClearCut knife 2 mm I-type (b, c). Partial dissection with ClearCut knife 2 mm I-type was performed (d). The resection was complemented by en bloc resection using an oval 15-mm diathermic snare (e) with eschar inspection and no complications (f).
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Citations
... However, regarding colorectal lesions, those 2-3 cm in size were found to be most suitable for H-ESD [18] . H-ESD has also been used for esophageal lipoma [19] , anal canal broma [20] , rectal neuroendocrine tumor [21,22] resection, and even for full-thickness resection of T2 colorectal cancer [23] . ...
Background and Objective This study aimed to evaluate the safety and efficiency of hybrid endoscopic submucosal dissection (H-ESD) using a newly developed ALL-IN-ONE (AIO) snare.
Methods This was a matched control study in a porcine model. Five paired simulated stomach lesions 2–2.5 cm in size were removed by H-ESD using an AIO snare or conventional ESD (C-ESD) using an endoscopic knife. The outcomes of the two procedures were compared, including en bloc resection rates, procedure times, intraprocedural bleeding volumes, muscular injuries, perforations, thicknesses of the submucosal layer in resected specimens, and stomach defects.
Results All simulated lesions were resected en bloc. Specimens resected by H-ESD and C-ESD were similar in size (7.68±2.92 vs. 8.42±2.42 cm²; P = 0.676). H-ESD required a significantly shorter procedure time (13.39±3.78 vs. 25.99±4.52 min; P = 0.031) and submucosal dissection time (3.99±1.73 vs. 13.1±4.58 min; P = 0.003) versus C-ESD; H-ESD also yielded a faster dissection speed (241.37±156.84 vs. 68.56±28.53 mm²/min; P = 0.042) and caused fewer intraprocedural bleeding events (0.40±0.55 vs. 3.40±1.95 times/per lesion; P = 0.016) than C-ESD. The thicknesses of the submucosal layer of the resected specimen (1190.98±134.07 vs. 1055.90±151.76 μm; P = 0.174) and the residual submucosal layer of the stomach defect (1607.94±1026.74 vs. 985.98±445.58 μm; P = 0.249) were similar with both procedures.
Conclusion The AIO snare is a safe and effective device for H-ESD and improves the treatment outcomes of gastric lesions by shortening the procedure time.
This study aimed to evaluate the safety and efficiency of hybrid endoscopic submucosal dissection (H-ESD) using a newly developed ALL IN ONE (AIO) snare. This was a matched control study in a porcine model. Five paired simulated stomach lesions 2–2.5 cm in size were removed by H-ESD using an AIO snare or conventional ESD (C-ESD) using an endoscopic knife. The outcomes of the two procedures were compared, including en-bloc resection rates, procedure times, intraprocedural bleeding volumes, muscular injuries, perforations, thicknesses of the submucosal layer in resected specimens, and stomach defects. All simulated lesions were resected en-bloc. Specimens resected by H-ESD and C-ESD were similar in size (7.68 ± 2.92 vs. 8.42 ± 2.42 cm²; P = 0.676). H-ESD required a significantly shorter procedure time (13.39 ± 3.78 vs. 25.99 ± 4.52 min; P = 0.031) and submucosal dissection time (3.99 ± 1.73 vs. 13.1 ± 4.58 min; P = 0.003) versus C-ESD; H-ESD also yielded a faster dissection speed (241.37 ± 156.84 vs. 68.56 ± 28.53 mm²/min; P = 0.042) and caused fewer intraprocedural bleeding events (0.40 ± 0.55 vs. 3.40 ± 1.95 times/per lesion; P = 0.016) than C-ESD. The thicknesses of the submucosal layer of the resected specimen (1190.98 ± 134.07 vs. 1055.90 ± 151.76 μm; P = 0.174) and the residual submucosal layer of the stomach defect (1607.94 ± 1026.74 vs. 985.98 ± 445.58 μm; P = 0.249) were similar with both procedures. The AIO snare is a safe and effective device for H-ESD and improves the treatment outcomes of gastric lesions by shortening the procedure time.
