Water pressure method for duodenal endoscopic submucosal dissection (with video).

Motohiko Kato, Yusaku Takatori, Motoki Sasaki, Mari Mizutani, Koshiro Tsutsumi, Yoshiyuki Kiguchi, Teppei Akimoto, Makoto Mutaguchi, Atsushi Nakayama, Kaoru Takabayashi, Tadateru Maehata, Takanori Kanai, Naohisa Yahagi

Journal: Gastrointestinal endoscopy 2021;93(4):942-949

PMID: 32853646

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND AIMS

Duodenal endoscopic submucosal dissection (ESD) is considered technically challenging and has a high risk of adverse events. However, we recently made some progress with the ESD technique and device by introducing 2 features: a water pressure (WP) method and a second-generation ESD knife (DualKnife) with a water jet function (DualKnife J). The present study aimed to assess whether these changes improved the clinical outcomes of duodenal ESD.

METHODS

This was a retrospective observational study. Among all patients who underwent ESD for superficial duodenal epithelial tumors from June 2010 to December 2018, patients in whom a single expert performed the procedure were included in this study. Various factors, including the use of the WP method and ESD devices (DualKnife or DualKnife J) and the treatment phase (early, mid, and late), were analyzed to determine whether they were associated with intraprocedural perforation and procedure time. Treatment phase was assigned by dividing the study population equally into 3 subgroups according to the treatment phase.

RESULTS

The procedure time was significantly shorter, and the proportion of patients with intraprocedural perforations was the lowest in the late phase. Multivariate analysis of the use of the WP method revealed that it significantly decreased the intraprocedural perforation rate (odds ratio, 0.39; 95% confidence interval, 0.16-0.96), and analysis of the use of both the WP method (β coefficient, -0.40; P < .01) and the DualKnife J (β coefficient, -0.10; P = .032) revealed they were independently and negatively correlated with procedure time.

CONCLUSION

The present study reveals that the WP method significantly reduced the intraprocedural perforation rate and that both the WP method and the DualKnife J significantly shortened procedure times for duodenal ESD.

Address: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan; Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.; Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.; Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

DOI: 10.1016/j.gie.2020.08.018