EMR + with the AWC improves endoscopic resection speed compared to ESD: a porcine ex-vivo pilot study

Abstract

Introduction

To improve resection speed and to reach higher en bloc resection rates in lesions ≥ 2 cm, a novel grasp and snare EMR technique termed “EMR+”, accomplished by an additional working channel (AWC), was developed. Its use compared to endoscopic submucosal dissection (ESD) is evaluated for the first time.

Material and methods

We prospectively conducted a randomized pre-clinical ex-vivo pilot study in explanted porcine stomachs for the comparison of EMR + with classical ESD of mucosal-based lesions. Prior to intervention, we set flat lesions with a standardized size of 3 × 3 cm.

Results

The median time of procedure was significantly shorter in the EMR + group (median 10.5 min, range 4.4–24 min) than in the ESD group (median 32 min, range 14–61.6 min, p < .0001). The rate of en bloc resection was significantly lower in the EMR + group (38 % vs. 95 %) (p < .0001). Nevertheless, an improvement in the learning curve for EMR + was achieved after the first 12 procedures, with a subsequent en bloc resection rate of 100 %.

Conclusions

EMR + could improve the efficiency of mucosal resection procedures. Initial experience demonstrates a higher and satisfactory en bloc resection rate after going through the learning curve of EMR+.

Keywords:

• Endoscopic mucosal resection (EMR)
• EMR + technique (EMR+)
• additional working channel (AWC)
• endoscopic submucosal dissection (ESD)
• RESECT+
• animal model
• EASIE-R model
• endoscopic triangulation

Acknowledgements

The authors would like to thank Song-Sa Dammer (former head nurse at St. Bernward Hospital Hildesheim) for her service and support during the experiments. Furthermore, we would like to thank Ovesco AG and FujiFilm Europe GmbH for providing devices and equipment. The study was carried out at the Farm Animal Genetics (FLI Mariensee) – we appreciate their staff for their assistance.

Declaration of interest

Richard Friedemann Knoop, Mark Andrew Gromski, Carlo Felix Maria Jung, Jürgen Maiss, Sinisa Milenovic, David Simon Klemme, Ulrich Baulain, Volker Ellenrieder and Peter Köhler have no financial ties to disclose. Edris Wedi has received lecture honorarium from OVESCO Endoscopy AG. Chi-Nghia Ho is Vice president of OVESCO Endoscopy AG and Gabor Conrad is a manager of Research and Development of OVESCO Endoscopy AG.