Author Discussion Series- Alexander Meining

Meining_Headshot_resizedA New Methods article from the April issue: “A new instrument for endoscopic submucosal dissection (with videos)” by Alexander Meining, MD, Armin Schneider, Daniel Roppenecker, and Tim Lüth

Alexander Meining, MD, from the II Medical Department, Klinikum rechts der Isar, Technical University of Munich in Germany, explains more about his article “A new instrument for endoscopic submucosal dissection (with videos).”

Endoscopic submucosal dissection (ESD) is a challenging procedure that is associated with a substantial risk of perforation. Hence, there is a demand for new devices that might potentially ease ESD and thereby reduce associated risks and overall time needed for the procedure. The study summarizes the collaborate experience (endoscopists, engineers, and biomedical industry) in constructing and evaluating such a new instrument (The Endo-Dissector) that was designed to enable almost all necessary steps of ESD and potentially reducing the technical challenges of ESD.

This study was conducted to gain more experience on the overall feasibility of using such a new instrument in an animal model.

This figure shows a schematic drawing of the new instrument. As demonstrated, it is based on forceps but there is an additional hook on one side for better tissue retraction during mucosal incision .

By performing gastric ESDs in female pigs, we were able to show that the new instrument has certain benefits. The main advantages appear to be that using a single instrument, all steps necessary for ESD (mucosal incision, submucosal dissection, and termination of arterial bleeding) can be performed. In addition, by grasping and lifting submucosal fibers before dissection, the risk of perforation might be reduced because contact with the muscle layer is avoided. However, our study is a very early feasibility study in the pig model with all interventions performed by a single investigator. Hence, it is necessary to gain much more experience in patients. Furthermore, other investigators have to confirm these early promising experiences. One of the shortcomings of the present study was that there was no histopathological assessment of resected specimens. Future data on the instrument will therefore also focus on the quality of specimens with respect to the histopathological examination.

The device has meanwhile been CE-marked. First patients have been treated with good results.

Read the abstract of this article here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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