Prospective randomized comparison of endoscopic submucosal tunnel dissection and conventional submucosal dissection in the resection of superficial esophageal/gastric lesions in a living porcine model

Abstract

Background and study aims: To assess experimentally endoscopicsubmucosal tunnel dissection (ESTD) as an alternative technique ofendoscopic submucosal resection.Patients and methods: This was a prospective, randomized, comparativeexperimental animal study carried out over a period of 9 months at thesurgical research and teaching center of Aix-Marseille University,France. Virtual esophageal and gastric lesions measuring 3cm in diameterwere resected in pigs weighing 25 to 30kg. The primary aim was toevaluate ESTD's efficacy compared with endoscopic submucosal dissection(ESD). The secondary aims were to determine complication rates as wellas to assess procedure time and procedure speed, histologic quality ofthe resected specimen, and procedure cost.Results: Eighteen procedures (9 ESD and 9 ESTD) were performed in ninepigs. The technical success rate was 88.9% for both techniques, withone single failure in each. The en bloc resection rate was 100% forESTD and 88.9% for ESD (one failure). The complication rate (22%) andmedian procedure time were similar but dissection speed was quicker withESTD in the esophagus (P=0.03). Median procedure cost (728 Euros for ESDand ESTD) did not differ. On histologic examination, the lateral marginswere healthy in 100% of ESTD and in 88.9% of ESD (P=0.49). Deepresection margins were of better quality in ESTD (median submucosalthickness: 1307.1 mu m vs. 884.7 mu m; P=0.039).Conclusions: ESTD is feasible and safe but not superior in the treatmentof superficial esophageal/gastric lesions in porcine models comparedwith ESD. Nevertheless it provides a better quality histologic specimen.