Cannula-guided snare with endoclip to assist in endoscopic submucosal dissection: an in vivo animal study

Background and objective: Assisted endoscopic submucosal dissection (ESD) with mucosal traction remains a challenge. This study explored an approach to assist in esophageal, gastric, colonic, and rectal ESD through a cannula-guided snare with endoclips (CSC-ESD), and aimed to preliminarily evaluate its feasibility in an in vivo porcine model. Material and methods: Forty-seven digestive tract mucosae in six pigs were resected using CSC-ESD. The operative time, operative success rate, en bloc resection rate, and intraoperative complications were evaluated. Results: The mean diameter of 12 resected esophageal mucosae was 4.4 ± 1.7 cm and the mean operative time was 24 ± 8 min. The mean diameter of 20 resected gastric mucosae was 3.8 ± 0.9 cm and the operative time was 35 ± 8 min. The mean diameter of 15 resected colonic and rectal mucosae was 3.6 ± 1.0 cm and the operative time was 34 ± 8 min. In all 47 resected mucosae, the en bloc resection rate was 100%, the operative success rate was 100%, and the intraoperative perforation rate was 4.3% (2/47) in the colon. No mucosal bruising or massive bleeding occurred during surgery. Conclusion: The results indicated that this novel assistive method is feasible in esophageal, gastric, colonic and rectal ESD. The further research is worthwhile.