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Comparison of ENDO CUT mode and FORCED COAG mode for the formation of stricture after esophageal endoscopic submucosal dissection in an in vivo porcine model

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Abstract

Background and study aim

Stricture is a major complication of esophageal endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma. To date, various methods have been developed to prevent stricture. However, the mechanism by which different electrosurgical unit (ESU) modes affect the formation of post-ESD stricture has not been evaluated. This study aimed to compare the degree of stricture caused by two major ESU modes (ENDO CUT mode and FORCED COAG mode) in a porcine model.

Methods

Twelve ESD procedures covering half of the circumference were performed in six pigs. Mucosal incision was performed with a ball-tip flush knife and submucosal dissection was performed with a hook knife; the two modes used were ENDO CUT I (Effect 2, Duration 2, Interval 3) and FORCED COAG mode (Effect 3, 40 W) (VIO300D, ERBE Germany). The pigs were killed humanely 30 days after ESD, and the severity of stricture and fibrosis was assessed.

Results

The resected site of the esophagus showed complete mucosal regrowth and scar formation in all pigs. There was no significant difference between the two modes in procedure time and size of resected specimen (14.4 ± 2.4 and 15.9 ± 6.1 min, P = 0.589; 626 ± 148, 661 ± 186 mm2, P = 0.74, respectively). Stricture rate and severity of fibrosis in the submucosal layer were significantly lower in ENDO CUT mode than in FORCED COAG mode (31.5 ± 16.0% vs 44.3 ± 11.6%, P = 0.046; 36.2 ± 17.1% vs 60.4 ± 26.8%, P = 0.024, respectively).

Conclusions

ENDO CUT mode showed promising ability to attenuate fibrosis and stricture after esophageal ESD.

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Funding

This study was funded by The Osaka Foundation for The Prevention of Cancer and Life-style-related Diseases.

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Authors and Affiliations

  1. Division of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Masamichi Arao, Ryu Ishihara, Taro Iwatsubo, Satoki Shichijyo, Noriko Matsuura, Hiroko Nakahira, Sachiko Yamamoto, Yoji Takeuchi, Koji Higashino & Noriya Uedo

  2. Division of Gastroenterology, Sanda City Hospital, Hyogo, Japan

    Ryu Ishihara & Yusuke Tonai

  3. Division of Pathology and Cytology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Shinichi Nakatsuka

Authors
  1. Masamichi Arao
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  2. Ryu Ishihara
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  3. Yusuke Tonai
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Correspondence to Ryu Ishihara.

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Disclosures

Ryu Ishihara, Masamichi Arao, Yusuke Tonai, Taro Iwatsubo, Satoki Shichijyo, Noriko Matsuura, Hiroko Nakahira, Sachiko Yamamoto, Yoji Takeuchi, Koji Higashino, Noriya Uedo, and Shinichi Nakatsuka have no conflicts of interest or financial ties to disclose.

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Arao, M., Ishihara, R., Tonai, Y. et al. Comparison of ENDO CUT mode and FORCED COAG mode for the formation of stricture after esophageal endoscopic submucosal dissection in an in vivo porcine model. Surg Endosc 32, 2902–2906 (2018). https://doi.org/10.1007/s00464-017-6000-4

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  • DOI: https://doi.org/10.1007/s00464-017-6000-4

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