Efficacy of a prototype endoscope with two deflecting working channels for endoscopic submucosal dissection: a prospective, comparative, ex vivo study

Background: Optimizing the visualization of the cutting line of the submucosal layer is essential to performing an effective and safe endoscopic submucosal dissection (ESD).

Objective: To evaluate the prototype R-scope compared with a conventional, double-channel endoscope in time required for ESD of mucosal lesions in distinct anatomical locations of the stomach.

Design: A prospective, comparative, ex vivo study.

Intervention: ESD.

Main outcome measurements: Procedure time (primary end point measure), specimen size, submucosal injection frequency, en bloc resection rate, and perforation rate (secondary end point measures).

Results: In the subgroup of resections in the greater and lesser curvature, the mean (+/- SD) procedure time was significantly less in the R-scope group compared with the conventional endoscope group (8.4 +/- 2.1 minutes vs 11.3 +/- 2.1 minutes, respectively; P = .006), and the mean (+/- SD) submucosal injection frequency was significantly less in the R-scope group compared with the conventional endoscope group (1.9 +/- 0.6 vs 2.5 +/- 0.5, respectively; P = .025). There were no significant differences in procedure time, specimen size, submucosal injection requirements, en bloc resection rate, and perforation rate between the two endoscopic groups of all combined anatomic lesions.

Limitations: Small, ex vivo study.

Conclusion: ESD by using the R-scope may provide an improved platform for quicker ESD, especially in greater and lesser curvature anatomical lesions of the stomach.