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Sharma SK, Hiratsuka T, Hara H, et al. Antigravity ESD - double-balloon-assisted underwater with traction hybrid technique. Endosc Int Open. 2018;6(6):E739-E744doi: 10.1055/a-0578-8081.
Sharma, S. K., Hiratsuka, T., Hara, H., & Milsom, J. W. (2018). Antigravity ESD - double-balloon-assisted underwater with traction hybrid technique. Endoscopy international open, 6(6), E739-E744. https://doi.org/10.1055/a-0578-8081
Sharma, Sam K, et al. "Antigravity ESD - double-balloon-assisted underwater with traction hybrid technique." Endoscopy international open vol. 6,6 (2018): E739-E744. doi: https://doi.org/10.1055/a-0578-8081
Sharma SK, Hiratsuka T, Hara H, Milsom JW. Antigravity ESD - double-balloon-assisted underwater with traction hybrid technique. Endosc Int Open. 2018 Jun;6(6):E739-E744. doi: 10.1055/a-0578-8081. Epub 2018 Jun 05. PMID: 29876511; PMCID: PMC5988544.
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Endosc Int Open. 2018 Jun;6(6):E739-E744. doi: 10.1055/a-0578-8081. Epub 2018 Jun 05.

Antigravity ESD - double-balloon-assisted underwater with traction hybrid technique.

Endoscopy international open

Sam K Sharma, Takahiro Hiratsuka, Hisashi Hara, Jeffrey W Milsom

Affiliations

  1. Minimally Invasive New Technologies, Department of Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, United States.

PMID: 29876511 PMCID: PMC5988544 DOI: 10.1055/a-0578-8081

Abstract

BACKGROUND AND STUDY AIMS:  Complex colorectal polyps or those positioned in difficult anatomic locations are an endoscopic therapeutic challenge. Underwater endoscopic submucosal dissection (UESD) is a potential technical solution to facilitate efficient polyp removal. In addition, endoscopic tissue retraction has been confined to limited methods of varying efficacy and complexity. The aim of this study was to evaluate the efficiency of a unique UESD technique for removing complex polyps using double-balloon-assisted retraction (R).

MATERIALS AND METHODS:  Using fresh ex-vivo porcine rectum, 4-cm polyps were created using electrosurgery and positioned at "6 o'clock" within an established ESD model. Six resections were performed in each group. Underwater techniques were facilitated using a novel double-balloon platform (Dilumen, Lumendi, Westport, Connecticut, United States).

RESULTS:  UESD-R had a significantly shorter total procedural time than cap-assisted ESD and UESD alone (24 vs. 58 vs. 56 mins). UESD-R produced a dissection time on average of 5 minutes, attributed to the retraction provided. There was also a subjective significant reduction in electrosurgical smoke with the underwater techniques contributing to improved visualization.

CONCLUSIONS:  Here we report the first ex-vivo experience of a unique double-balloon endoscopic platform optimized for UESD with tissue traction capability. UESD-R removed complex lesions in significantly shorter time than conventional means. The combined benefits of UESD and retraction appeared to be additive when tackling complex polyps and should be studied further.

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