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. 2015 Aug;3(4):E368-72.
doi: 10.1055/s-0034-1391902. Epub 2015 Apr 14.

High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience

Mathieu Pioche  1 , Vincent Lépilliez  2 , Pierre Déprez  3 , Marc Giovannini  4 , Fabrice Caillol  4 , Hubert Piessevaux  3 , Jérôme Rivory  5 , Olivier Guillaud  5 , Mihai Ciocîrlan  6 , Damien Salmon  7 , Isabelle Lienhart  5 , Cyril Lafon  8 , Jean-Christophe Saurin  5 , Thierry Ponchon  9
Affiliations

High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience

Mathieu Pioche et al. Endosc Int Open. 2015 Aug.

Abstract

Background: Long lasting elevation is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water jet injection of saline solution or by viscous macromolecular solutions. In a previous animal study, we assessed the Nestis Enki II system to combine jet injection and viscous solutions. In the present work, we used this combination in humans in different sites of the digestive tract.

Methods: We retrospectively report all of the consecutive ESD procedures performed with jet injection of viscous solutions in four centers. Information was collected about the lesion, the procedure, the histological result, and the outcomes for the patient.

Results: In total, 45 resections were completed by six operators: five experts and one beginner with only one previous experience in human ESD. Lesions were located in the esophagus (10), the stomach (11), the duodenum (1), the colon (1) and the rectum (22). Average maximal lesion diameter was 4.8 cm (SD 2.4, range 2 - 11 cm), average lesion surface area was 19.8 cm(2) (SD 17.7, range 2.2 - 72 cm(2)), and average duration of procedure was 79.9 min (SD 50.3 min, range 19 - 225 min). ESD could be conducted while the endoscope was retroflexed at its maximum in 26 cases. Four adverse events were observed: two diminutive perforations and two delayed bleeding occurrences treated conservatively. The R0 resection rate was 91.1 %. The catheter was obstructed in six occurrences of bleeding.

Conclusion: Endoscopic submucosal dissection using high pressure injection of viscous macromolecular solutions is safe and effective in different parts of the digestive tract. It does not impede working with the endoscope in the maximal retroflexed position.

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Conflict of interest statement

Competing interests: Mathieu Pioche received a grant for clinical research from Nestis company.

Figures

Fig. 1
Fig. 1
Nestis Enki II® system: a operating principles; b schematic injection in the submucosal tissue, c catheter; d endoscopic view of the catheter during an endoscopic submucosal dissection (ESD) procedure.
Fig. 2
Fig. 2
Images of a procedure using Nestis® for a lateral spreading tumor (nongranular type) (LST-NG) of the rectum: a after marking, before first injection; b first injection through the mucosa; c first cutting; d submucosal dissection; e end of dissection; f piece stretching.
See this image and copyright information in PMC

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