Lowering the setting value of the esophageal endoscopic submucosal dissection device enabled tissue damage control in vitro porcine model

Sci Rep. 2022 Feb 23;12(1):3071. doi: 10.1038/s41598-022-06533-9.

Abstract

One of the complications of esophageal endoscopic submucosal dissection (ESD) is postoperative stricture formation. Stenosis formation is associated with inflammation and fibrosis in the healing process. We hypothesized that the degree of thermal damage caused by the device is related to stricture formation. We aimed to reveal the relationship between thermal damage and setting value of the device. We energized a resected porcine esophagus using the ESD device (Flush Knife 1.5). We performed 10 energization points for 1 s, 3 s, and 5 s at four setting values of the device. We measured the amount of current flowing to the conducted points and the temperature and evaluated the effects of thermal damage pathologically. As results, the mean highest temperatures for 1 s were I (SWIFT Effect3 Wat20): 61.19 °C, II (SWIFT Effect3 Wat30): 77.28 °C, III (SWIFT Effect4 Wat20): 94.50 °C, and IV (SWIFT Effect4 Wat30): 94.29 °C. The mean heat denaturation areas were I: 0.84 mm2, II: 1.00 mm2, III: 1.91 mm2, and IV: 1.54 mm2. The mean highest temperature and mean heat denaturation area were significantly correlated (P < 0.001). In conclusion, Low-current ESD can suppress the actual temperature and thermal damage in the ESD wound.

MeSH terms

  • Animals
  • Endoscopic Mucosal Resection / adverse effects*
  • Endoscopic Mucosal Resection / instrumentation
  • Endoscopic Mucosal Resection / methods*
  • Esophageal Mucosa / injuries*
  • Esophagectomy / adverse effects*
  • Esophagectomy / instrumentation*
  • Esophagectomy / methods
  • Esophagoscopes / adverse effects*
  • Esophagoscopy / adverse effects*
  • Esophagoscopy / methods*
  • Hot Temperature / adverse effects*
  • Models, Anatomic
  • Postoperative Complications / etiology*
  • Postoperative Complications / prevention & control*
  • Swine