Clinical Endoscopy

Original Articles

Dedicated Cold Snare vs. Traditional Snare for Polypectomy of Diminutive and Small Lesions in a Porcine Model: A Research Group for Endoscopic Instruments and Stents (REIS) Study: Han Hee Lee, Bo-In Lee, Jung-Wook Kim, Hyun Lim, Si Hyung Lee, Jun-Hyung Cho, Yunho Jung, Kyoung Oh Kim, Chan Gyoo Kim, Kee Myung Lee, Jong-Jae Park, Myung-Gyu Choi, Hoon Jai Chun, Ho Gak Kim; Clin Endosc 2021;54(3):390-396. Published online September 10, 2020; DOI: https://doi.org/10.5946/ce.2020.096

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Background
/Aims: The aim of this in vivo animal study was to evaluate the effectiveness and safety of dedicated cold snare (DCS) compared with those of traditional snare (TS) for cold snare polypectomy (CSP).
Methods
A total of 36 diminutive (5 mm) and 36 small (9 mm) pseudolesions were made by electrocoagulation in the colons of mini-pigs.
Results
For the diminutive lesions, there were no significant differences in technical success rate, procedure time, or complete resection rate between the DCS and TS groups; the rate of uneven resection margin in the DCS group was significantly lower than that of the TS group. For small lesions, technical success rate and complete resection rate were significantly higher in the DCS group than in the TS group (100% [18/18] vs. 55.6% [10/18], p=0.003; 94.4% [17/18] vs. 40% [4/10], p=0.006). In addition, the procedure duration was significantly shorter, and the rate of uneven resection margin was significantly lower in the DCS group (28.5 sec vs. 66.0 sec, p=0.006; 11.1% [2/18] vs. 100% [10/10], p<0.001). Two cases of perforation occurred in the DCS group. Multivariate analysis revealed that DCS use was independently associated with complete resection.
Conclusions
DCS is superior to TS in terms of technical success, complete resection, and reducing the duration of the procedure for CSP of small polyps.

Citations

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Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study
Toshiki Horii, Sho Suzuki, Akihiro Sugita, Misa Yamauchi, Hisatomo Ikehara, Chika Kusano, Takuji Gotoda
Journal of Gastroenterology and Hepatology.2023; 38(5): 752. CrossRef
Comparison of the clinical efficacy of cold snare polypectomy using a thin-wire snare and thick-wire snare for small colorectal polyps
Hong Jin Yoon, Yunho Jung, Young Sin Cho, Il-Kwun Chung
International Journal of Gastrointestinal Intervention.2023; 12(4): 183. CrossRef
Big Issues on Small Polyps: An Ideal Device, But Is It for an Ideal Indication?
Yoji Takeuchi
Clinical Endoscopy.2021; 54(3): 297. CrossRef
Cold versus hot polypectomy/endoscopic mucosal resection–A review of current evidence
Raquel Ortigão, Jochen Weigt, Ahmed Afifi, Diogo Libânio
United European Gastroenterology Journal.2021; 9(8): 938. CrossRef

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Peroral Endoscopic Myotomy for Treating Achalasia in an Animal Model: A Feasibility Study: Byoung Wook Bang, Young Chul Choi, Hyung Gil Kim, Kye Sook Kwon, Yong Woon Shin, Don Haeng Lee, Joon Mee Kim; Clin Endosc 2013;46(1):54-58. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.54

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Background/Aims

Laparoscopic Heller myotomy with antireflux procedure is considered to be a standard treatment for achalasia. Recently, peroral endoscopic myotomy (POEM) was developed and performed on patients with achalasia. However, there is no report on POEM use in South Korea. The aim of this study was to evaluate the technical feasibility of POEM in a porcine model.

Methods

POEM was performed on two mini pigs. We performed upper endoscopy under general anesthesia. A submucosal tunnel was created and the circular muscle layer was incised using several knives. The mucosal entry was closed using resolution clips. We performed a follow-up endoscopy and sacrificed the pigs 2 weeks after the POEM. The myotomy site was evaluated grossly and histologically.

Results

POEM was successfully performed on the two mini pigs. No injuries to any abdominal or mediastinal structures occurred. Two weeks after the POEM, the esophageal mucosa healed without any endoscopic evidence of complications. Necropsy revealed that the circular muscle layer was completely lost and replaced with fibrotic tissue.

Conclusions

We found that POEM is a technically feasible method which can be performed on an animal model. However, to ensure safe use on patients with achalasia, further studies on technical methods and long-term follow-up examinations are required.

Citations

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Pilot prospective study on formal training in per-oral endoscopic myotomy (POEM) during advanced endoscopy fellowship
Salmaan Jawaid, Peter V. Draganov, Hiroyuki Aihara, Mouen A. Khashab, Dennis Yang
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Miotomía endoscópica peroral, experiencia in vivo : imprescindible para desarrollo de la técnica en humanos
A. Peñaloza-Ramírez, J. Suárez-Correa, J. Báez-Blanco, C. Sabogal-Gómez, H. Kuan-Casas, C. Sánchez-Pignalosa, P. Aponte-Ordóñez
Revista de Gastroenterología de México.2018; 83(2): 86. CrossRef
In vivo experience with peroral endoscopic myotomy: An essential activity for developing the technique in humans
A. Peñaloza-Ramírez, J. Suárez-Correa, J. Báez-Blanco, C. Sabogal-Gómez, H. Kuan-Casas, C. Sánchez-Pignalosa, P. Aponte-Ordóñez
Revista de Gastroenterología de México (English Edition).2018; 83(2): 86. CrossRef
Factors predicting the technical difficulty of peroral endoscopic myotomy for achalasia
Xiaowei Tang, Yutang Ren, Zhengjie Wei, Jieqiong Zhou, Zhiliang Deng, Zhenyu Chen, Bo Jiang, Wei Gong
Surgical Endoscopy.2016; 30(9): 3774. CrossRef
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Chenjie Li, Yuyong Tan, Xuehong Wang, Deliang Liu
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Sakai P
Gastroenterology & Hepatology: Open Access.2015;[Epub] CrossRef
International Digestive Endoscopy Network 2014: Turnpike to the Future
Eun Young Kim, Kwang An Kwon, Il Ju Choi, Ji Kon Ryu, Ki Baik Hahm
Clinical Endoscopy.2014; 47(5): 371. CrossRef
Training for peroral endoscopic myotomy
Daniel von Renteln, Melina C. Vassiliou, Thomas Rösch
Techniques in Gastrointestinal Endoscopy.2013; 15(3): 153. CrossRef
Peroral Endoscopic Myotomy for the Treatment of Achalasia: An Analysis
Dennis Yang, Mihir S. Wagh
Diagnostic and Therapeutic Endoscopy.2013; 2013: 1. CrossRef
Peroral Endoscopic Myotomy in a Porcine Model: A Step to Achalasia Patients
Su Jin Hong
Clinical Endoscopy.2013; 46(1): 1. CrossRef

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Focused Review Series: Globalization and Universalizations of ESD

Ex Vivo and In Vivo Models for Endoscopic Submucosal Dissection Training: Adolfo Parra-Blanco, Nicolas Gonzalez, Maria Rosa Arnau; Clin Endosc 2012;45(4):350-357. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.350

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Endoscopic submucosal dissection is a technically challenging but highly effective technique for the treatment of well selected early neoplasms in the digestive tract. Although it is frequently performed in East Asian countries, the Western world has not adopted this technique yet, probably due in part to the difficulty to learn it. Ex vivo and in vivo animal models are invaluable tools to overcome at least the beginning of the learning curve, although the initial step is the acquisition of basic knowledge about early diagnosis of neoplasias, and observing real procedures in expert centers. The practical issues, advantages, and disadvantages of the ex vivo and in vivo models are discussed.

Citations

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Clinical Endoscopy.2023; 56(1): 1. CrossRef
Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study
Dong Seok Lee, Gin Hyug Lee, Sang Gyun Kim, Kook Lae Lee, Ji Won Kim, Ji Bong Jeong, Yong Jin Jung, Hyoun Woo Kang
Clinical Endoscopy.2023; 56(5): 604. CrossRef
A survey of physician training and credentialing in endoscopic submucosal dissection in the United States
Sohi Mistry, Omar Alaber, Apoorva Krishna Chandar, Lady Katherine Mejia Perez, John Dumot, Amit Bhatt, Amitabh Chak
Surgical Endoscopy.2022; 36(5): 2794. CrossRef
The colonoscopic vacuum model–simulating biomechanical restrictions to provide a realistic colonoscopy training environment
Jana Steger, Christina Kwade, Maximilian Berlet, Roman Krumpholz, Stefanie Ficht, Dirk Wilhelm, Petra Mela
International Journal of Computer Assisted Radiology and Surgery.2022; 18(1): 105. CrossRef
An innovative next-generation endoscopic submucosal injection material with a 2-step injection system (with video)
Ryohei Hirose, Takaaki Nakaya, Yuji Naito, Takuma Yoshida, Risa Bandou, Tomo Daidoji, Ken Inoue, Osamu Dohi, Naohisa Yoshida, Yoshito Itoh
Gastrointestinal Endoscopy.2021; 93(2): 503. CrossRef
Differences between two sodium hyaluronate-based submucosal injection materials currently used in Japan based on viscosity analysis
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Takuma Noguchi, Hisanao Hazama, Takahiro Nishimura, Yoshinori Morita, Kunio Awazu
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Gastrointestinal Endoscopy.2015; 81(6): 1311. CrossRef
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Endoscopic Submucosal Dissection (ESD) Training and Performing ESD with Accurate and Safe Techniques: Chang-Il Kwon; Clin Endosc 2012;45(4):347-349. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.347

Abstract PDF PubReader ePub

Introduction of endoscopic submucosal dissection (ESD) has brought about a renaissance in therapeutic endoscopy. For the globalization and universalization of ESD, the number of physicians who can perform ESD has rapidly increased with general ex vivo and in vivo training using animal models and hand-on courses. In this focused review series, world-renowned ESD experts described the published studies or their own precious experiences about ESD training and performing ESD with accurate and safe techniques. First, Dr. Adolfo Parra-Blanco reviewed on ex vivo and in vivo models for ESD training. Next, Dr. Joo Young Cho described detailed practical settings and current status of hands-on courses using ex vivo and in vivo models in Korea. Dr. Takashi Toyonaga described quality controlled ESD and basic techniques to prevent complications. Dr. Tsuneo Oyama reviewed recently published methods to facilitate ESD. Dr. Jae-Young Jang reviewed the usefulness of magnifying and narrow band imaging to measure the depth of invasion before ESD.

Citations

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Endoscopic submucosal dissection training: evaluation of an ex vivo training model with continuous perfusion (ETM-CP) for hands-on teaching and training in China
Jun Huang, Bing-ran Du, Wei-guang Qiao, Si-lin Huang, Lan-feng Xue, Liang Deng, Jun-ming Liang, Jun Wang, Jian-yi Li, Yu Chen
Surgical Endoscopy.2023; 37(6): 4774. CrossRef
Disección endoscópica submucosa: curva de aprendizaje en modelos porcinos
Victor Efrén Gallardo Cabrera, Oscar Hernández Mondragón, Dulce María Rascón Martínez, Gerardo Blanco Velasco, Roberto Ramos González, Amina Evelyn Tun Abraham, Juan Manuel Blancas Valencia
Endoscopia.2015; 27(3): 109. CrossRef
Training in endoscopic submucosal dissection
Roxana M Coman
World Journal of Gastrointestinal Endoscopy.2013; 5(8): 369. CrossRef

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