Gastric endoscopic submucosal dissection using novel 26-mm articulating devices: an ex vivo comparative and in vivo feasibility study

Background and study aims: The conventional procedure of endoscopic submucosal dissection (ESD) is technically demanding. This study investigated the efficiency of novel articulating devices (maximum diameter 2.6mm), which can be used with commercially available, standard endoscopes. Patients and methods: In an ex vivo comparative study, eight endoscopists were divided into novices and experienced operators, and performed ESD using new devices and the conventional setup. An in vivo animal experiment was performed by two experts. Procedure times for incision and dissection were recorded, and unit times for circumferential length and area of specimens were calculated. Results: All procedures were successfully completed with en bloc resection. In the ex vivo study, the unit procedure times for incision and dissection by novices were significantly shorter using the new system (P<0.01 and P<0.05), whereas there was no significant difference for experienced endoscopists. Perforation occurred during one procedure in which the new system was used. The in vivo experiments were successfully completed without adverse events. Conclusions: ESD using novel articulating devices was feasible. These devices were able to reduce the procedure time for novices.