Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model

Yusuke Tonai, Ryu Ishihara, Yasushi Yamasaki, Masamichi Arao, Taro Iwatsubo, Minoru Kato, Syo Suzuki, Kenta Hamada, Satoki Shichijo, Noriko Matsuura, Takashi Kanesaka, Hiroko Nakahira, Sachiko Yamamoto, Tomofumi Akasaka, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Yasuhiko Tomita, Hiroyasu Iishi

Research output: Contribution to journalArticle

Abstract

Background and aim:  Strictures are a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Post ESD, stricture develops during the process of scar formation, which is related to inflammation caused by ESD. We planned a study to evaluate whether certain electrosurgical unit modes could attenuate strictures after esophageal ESD.

Methods:  A total of 16 ESD, three-quarters of the esophageal circumference, were performed in four live pigs. A ball-tip Flush knife was used for mucosal incision. Submucosal dissection was performed using a Hook knife in monopolar mode and a ball-tip Jet B-knife in bipolar mode. Applied electrosurgical unit modes were FORCED COAG, SWIFT COAG, SPRAY COAG, ENDO CUT in monopolar mode, and FORCED COAG in bipolar mode. One month after ESD, the pigs were killed humanely and the severity of strictures and fibrosis was assessed.

Results:  The resected site in the esophagus showed complete mucosal regrowth and scar formation in all pigs. The quotients of stricture following ENDO CUT, SWIFT COAG, FORCED COAG effect2, FORCED COAG effect3, FORCED COAG effect4, SPRAY COAG, and Bipolar FORCED COAG mode were 16 %, 28 %, 38 %, 33 %, 51 %, 39 %, and 47 %, respectively. The equivalent quotients of fibrosis were 7 %, 28 %, 31 %, 30 %, 35 %, 63 %, and 100 %, respectively. ENDO CUT mode was associated with the lowest mean quotients of stricture and fibrosis.

Conclusion:  ENDO CUT mode showed promising results to attenuate fibrosis and strictures after esophageal ESD.

Original languageEnglish
Pages (from-to)E376-E381
JournalEndoscopy international open
Volume6
Issue number3
DOIs
Publication statusPublished - Mar 2018
Externally publishedYes

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Pathologic Constriction
Swine
Fibrosis
Esophageal Stenosis
Cicatrix
Endoscopic Mucosal Resection
Esophagus
Dissection
Inflammation
Carcinoma

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Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model. / Tonai, Yusuke; Ishihara, Ryu; Yamasaki, Yasushi; Arao, Masamichi; Iwatsubo, Taro; Kato, Minoru; Suzuki, Syo; Hamada, Kenta; Shichijo, Satoki; Matsuura, Noriko; Kanesaka, Takashi; Nakahira, Hiroko; Yamamoto, Sachiko; Akasaka, Tomofumi; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Uedo, Noriya; Tomita, Yasuhiko; Iishi, Hiroyasu.

In: Endoscopy international open, Vol. 6, No. 3, 03.2018, p. E376-E381.

Research output: Contribution to journalArticle

Tonai, Y, Ishihara, R, Yamasaki, Y, Arao, M, Iwatsubo, T, Kato, M, Suzuki, S, Hamada, K, Shichijo, S, Matsuura, N, Kanesaka, T, Nakahira, H, Yamamoto, S, Akasaka, T, Hanaoka, N, Takeuchi, Y, Higashino, K, Uedo, N, Tomita, Y & Iishi, H 2018, 'Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model', Endoscopy international open, vol. 6, no. 3, pp. E376-E381. https://doi.org/10.1055/s-0043-122883
Tonai, Yusuke ; Ishihara, Ryu ; Yamasaki, Yasushi ; Arao, Masamichi ; Iwatsubo, Taro ; Kato, Minoru ; Suzuki, Syo ; Hamada, Kenta ; Shichijo, Satoki ; Matsuura, Noriko ; Kanesaka, Takashi ; Nakahira, Hiroko ; Yamamoto, Sachiko ; Akasaka, Tomofumi ; Hanaoka, Noboru ; Takeuchi, Yoji ; Higashino, Koji ; Uedo, Noriya ; Tomita, Yasuhiko ; Iishi, Hiroyasu. / Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model. In: Endoscopy international open. 2018 ; Vol. 6, No. 3. pp. E376-E381.
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abstract = "Background and aim:  Strictures are a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Post ESD, stricture develops during the process of scar formation, which is related to inflammation caused by ESD. We planned a study to evaluate whether certain electrosurgical unit modes could attenuate strictures after esophageal ESD.Methods:  A total of 16 ESD, three-quarters of the esophageal circumference, were performed in four live pigs. A ball-tip Flush knife was used for mucosal incision. Submucosal dissection was performed using a Hook knife in monopolar mode and a ball-tip Jet B-knife in bipolar mode. Applied electrosurgical unit modes were FORCED COAG, SWIFT COAG, SPRAY COAG, ENDO CUT in monopolar mode, and FORCED COAG in bipolar mode. One month after ESD, the pigs were killed humanely and the severity of strictures and fibrosis was assessed.Results:  The resected site in the esophagus showed complete mucosal regrowth and scar formation in all pigs. The quotients of stricture following ENDO CUT, SWIFT COAG, FORCED COAG effect2, FORCED COAG effect3, FORCED COAG effect4, SPRAY COAG, and Bipolar FORCED COAG mode were 16 {\%}, 28 {\%}, 38 {\%}, 33 {\%}, 51 {\%}, 39 {\%}, and 47 {\%}, respectively. The equivalent quotients of fibrosis were 7 {\%}, 28 {\%}, 31 {\%}, 30 {\%}, 35 {\%}, 63 {\%}, and 100 {\%}, respectively. ENDO CUT mode was associated with the lowest mean quotients of stricture and fibrosis.Conclusion:  ENDO CUT mode showed promising results to attenuate fibrosis and strictures after esophageal ESD.",
author = "Yusuke Tonai and Ryu Ishihara and Yasushi Yamasaki and Masamichi Arao and Taro Iwatsubo and Minoru Kato and Syo Suzuki and Kenta Hamada and Satoki Shichijo and Noriko Matsuura and Takashi Kanesaka and Hiroko Nakahira and Sachiko Yamamoto and Tomofumi Akasaka and Noboru Hanaoka and Yoji Takeuchi and Koji Higashino and Noriya Uedo and Yasuhiko Tomita and Hiroyasu Iishi",
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T1 - Impact of electrosurgical unit mode on post esophageal endoscopic submucosal dissection stricture in an in vivo porcine model

AU - Tonai, Yusuke

AU - Ishihara, Ryu

AU - Yamasaki, Yasushi

AU - Arao, Masamichi

AU - Iwatsubo, Taro

AU - Kato, Minoru

AU - Suzuki, Syo

AU - Hamada, Kenta

AU - Shichijo, Satoki

AU - Matsuura, Noriko

AU - Kanesaka, Takashi

AU - Nakahira, Hiroko

AU - Yamamoto, Sachiko

AU - Akasaka, Tomofumi

AU - Hanaoka, Noboru

AU - Takeuchi, Yoji

AU - Higashino, Koji

AU - Uedo, Noriya

AU - Tomita, Yasuhiko

AU - Iishi, Hiroyasu

PY - 2018/3

Y1 - 2018/3

N2 - Background and aim:  Strictures are a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Post ESD, stricture develops during the process of scar formation, which is related to inflammation caused by ESD. We planned a study to evaluate whether certain electrosurgical unit modes could attenuate strictures after esophageal ESD.Methods:  A total of 16 ESD, three-quarters of the esophageal circumference, were performed in four live pigs. A ball-tip Flush knife was used for mucosal incision. Submucosal dissection was performed using a Hook knife in monopolar mode and a ball-tip Jet B-knife in bipolar mode. Applied electrosurgical unit modes were FORCED COAG, SWIFT COAG, SPRAY COAG, ENDO CUT in monopolar mode, and FORCED COAG in bipolar mode. One month after ESD, the pigs were killed humanely and the severity of strictures and fibrosis was assessed.Results:  The resected site in the esophagus showed complete mucosal regrowth and scar formation in all pigs. The quotients of stricture following ENDO CUT, SWIFT COAG, FORCED COAG effect2, FORCED COAG effect3, FORCED COAG effect4, SPRAY COAG, and Bipolar FORCED COAG mode were 16 %, 28 %, 38 %, 33 %, 51 %, 39 %, and 47 %, respectively. The equivalent quotients of fibrosis were 7 %, 28 %, 31 %, 30 %, 35 %, 63 %, and 100 %, respectively. ENDO CUT mode was associated with the lowest mean quotients of stricture and fibrosis.Conclusion:  ENDO CUT mode showed promising results to attenuate fibrosis and strictures after esophageal ESD.

AB - Background and aim:  Strictures are a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. Post ESD, stricture develops during the process of scar formation, which is related to inflammation caused by ESD. We planned a study to evaluate whether certain electrosurgical unit modes could attenuate strictures after esophageal ESD.Methods:  A total of 16 ESD, three-quarters of the esophageal circumference, were performed in four live pigs. A ball-tip Flush knife was used for mucosal incision. Submucosal dissection was performed using a Hook knife in monopolar mode and a ball-tip Jet B-knife in bipolar mode. Applied electrosurgical unit modes were FORCED COAG, SWIFT COAG, SPRAY COAG, ENDO CUT in monopolar mode, and FORCED COAG in bipolar mode. One month after ESD, the pigs were killed humanely and the severity of strictures and fibrosis was assessed.Results:  The resected site in the esophagus showed complete mucosal regrowth and scar formation in all pigs. The quotients of stricture following ENDO CUT, SWIFT COAG, FORCED COAG effect2, FORCED COAG effect3, FORCED COAG effect4, SPRAY COAG, and Bipolar FORCED COAG mode were 16 %, 28 %, 38 %, 33 %, 51 %, 39 %, and 47 %, respectively. The equivalent quotients of fibrosis were 7 %, 28 %, 31 %, 30 %, 35 %, 63 %, and 100 %, respectively. ENDO CUT mode was associated with the lowest mean quotients of stricture and fibrosis.Conclusion:  ENDO CUT mode showed promising results to attenuate fibrosis and strictures after esophageal ESD.

U2 - 10.1055/s-0043-122883

DO - 10.1055/s-0043-122883

M3 - Article

C2 - 29527561

VL - 6

SP - E376-E381

JO - Endoscopy international open

JF - Endoscopy international open

SN - 2364-3722

IS - 3

ER -