Post written by Vivek Kaul, MD, FACG, FASGE, AGAF, from the Department of Medicine, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA.

Standard endoluminal resection using established EMR and ESD techniques can be difficult and risky when attempting to remove fibrotic or scarred lesions. For the first time, we have access to a powered, nonthermal endoscopic tissue resection device that enables a controlled resection of such difficult to remove lesions using a combination of rotary and suction techniques under direct vision. This study was important to assess the technical feasibility, safety, and efficacy of this new technology and is the first U.S. report on this device.

In our multicenter study, 40 of 41 lesions in 34 patients were successfully removed with the powered endoscopic debridement (PED) device. Esophageal, duodenal, and colorectal lesions were all amenable to resection with this device. Saline and epinephrine injection into the lesion is used prior to resection. Tissue obtained from PED was adequate for histological interpretation. Given its fragmented nature, the specimen cannot be used for pathological staging (like an EMR or ESD specimen) but can help differentiate adenoma/dysplasia from carcinoma.

Of the patients who underwent a follow-up exam, only about 20% had residual/recurrent lesions in this difficult population. Patients tolerated the procedure well with only minor adverse events including 2 patients with delayed bleeding (hemostasis was achieved with repeat endoscopy and standard endoscopic techniques) and 1 patient with self-limited postprocedure chest pain after PED of an esophageal lesion. 

Future prospective studies will further clarify the role of this novel device, including cost effectiveness, long-term durability of results, and comparison with other modalities currently in use for similar indications.

Figure 1. EndoRotor console and catheter.

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