East Meets West—A Novel Steerable Grasper to Facilitate Gastric Endoscopic Submucosal Dissection (ESD): Randomized Comparative Study in a Porcine Model

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Abstract

Background. Endoscopic submucosal dissection (ESD) is challenging because of the limited ability of conventional endoscopic tools to achieve adequate traction. We have recently used a novel steerable grasper (SG; ANUBIS grasper, Karl Storz, Tüttlingen, Germany) with intuitive manipulating handles to lift up the mucosa. The aim of this study is to evaluate the efficacy of the assistance of the SG in a porcine acute model. Materials and methods. A total of 36 gastric ESDs were performed in 12 swine (3 ESDs/pig), at the antrum, greater curvature of the gastric body, and cardia. Pigs were randomly assigned to the SG group (n = 6) or to the control group (n = 6). ESD steps included the following: scoring the area, submucosal injection, and precut and submucosal dissection with or without SG assistance. Outcomes measured were as follows: dissection time, dissection speed, size of specimen, completeness of dissection (all marks included in the specimen), en bloc dissection, and complications. Results. Overall mean dissection time was 18.6 ± 7.56 versus 29 ± 18.14 minutes (P = .032), and mean dissection speed was 94.74 ± 39.74 mm2/min versus 65.41 ± 39.5 mm2/min (P = .033) in the SG and control groups, respectively. Mean size of the specimen was 1451.4 ± 549.2 mm2 in the SG group and 1615.3 ± 605.9 in the control group. Complete and en bloc dissections were achieved in all cases. One deep muscular injury occurred in the control group (gastric body). Conclusion. The ANUBIS grasper is a user-friendly, effective, and safe tool to achieve adequate traction and exposure of the ESD plane in the pig model.

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