Can mechanical balloon dissection be applied to cleave fibrotic submucosal tissues? A pilot study in a porcine model

A. Dobashi, K. Sumiyama, C. J. Gostout, T. R. Ohya, M. Kobayashi, H. Imazu, H. Tajiri

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background and study aims: Removal of a lesion containing an ulcer scar is one of the most challenging applications of endoscopic submucosal dissection (ESD). The present study examined whether a novel balloon dissector could cleave fibrotic submucosal tissue beneath ulcer scars. Methods: Six pigs were studied. Endoscopic mucosal resection (EMR) with ligation was performed at 7 or 8 sites in the stomach for each animal; 4 weeks later, 23 sites with a visible scar were selected for submucosal dissection. The procedure involved first creating a submucosal fluid cushion (SFC) by injecting either saline mixed with mesna or pure saline. A slender, compliant balloon with a diameter of 8, 13, or 18 mm was inserted into the SFC. The balloon was unfolded and thrust forward to cleave the fibrotic submucosa over approximately 5 cm. Results: Fibrotic submucosa was dissected within 90 seconds in 17 of 23 attempts. Isolating the ulcer scar from the muscularis with the SFC prior to balloon dissection and using a thinner balloon catheter both ensured a better dissection. Conclusions: The fibrotic submucosa underlying post-EMR scars can be dissected with the novel balloon dissector, although the technique is less effective in cases with no sign of lifting.

Original languageEnglish (US)
Pages (from-to)661-666
Number of pages6
JournalEndoscopy
Volume45
Issue number8
DOIs
StatePublished - Jul 1 2013

ASJC Scopus subject areas

  • Gastroenterology

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    Dobashi, A., Sumiyama, K., Gostout, C. J., Ohya, T. R., Kobayashi, M., Imazu, H., & Tajiri, H. (2013). Can mechanical balloon dissection be applied to cleave fibrotic submucosal tissues? A pilot study in a porcine model. Endoscopy, 45(8), 661-666. https://doi.org/10.1055/s-0033-1344126