Efficacy of a prototype endoscope with two deflecting working channels for endoscopic submucosal dissection: a prospective, comparative, ex vivo study

Background

Optimizing the visualization of the cutting line of the submucosal layer is essential to performing an effective and safe endoscopic submucosal dissection (ESD).

Objective

To evaluate the prototype R-scope compared with a conventional, double-channel endoscope in time required for ESD of mucosal lesions in distinct anatomical locations of the stomach.

Design

A prospective, comparative, ex vivo study.

Intervention

ESD.

Main Outcome Measurements

Procedure time (primary end point measure), specimen size, submucosal injection frequency, en bloc resection rate, and perforation rate (secondary end point measures).

Results

In the subgroup of resections in the greater and lesser curvature, the mean (± SD) procedure time was significantly less in the R-scope group compared with the conventional endoscope group (8.4 ± 2.1 minutes vs 11.3 ± 2.1 minutes, respectively; P = .006), and the mean (± SD) submucosal injection frequency was significantly less in the R-scope group compared with the conventional endoscope group (1.9 ± 0.6 vs 2.5 ± 0.5, respectively; P = .025). There were no significant differences in procedure time, specimen size, submucosal injection requirements, en bloc resection rate, and perforation rate between the two endoscopic groups of all combined anatomic lesions.

Limitations

Small, ex vivo study.

Conclusion

ESD by using the R-scope may provide an improved platform for quicker ESD, especially in greater and lesser curvature anatomical lesions of the stomach.

Abbreviations: EMR, endoscopic mucosal resection, ESD, endoscopic submucosal dissection, NOTES, natural orifice translumenal endoscopic surgery