Safe and effective hybrid endoscopic submucosal dissection with ALL IN ONE snare in porcine gastric model (with video)

This study aimed to evaluate the safety and efficiency of hybrid endoscopic submucosal dissection (H-ESD) using a newly developed ALL IN ONE (AIO) snare. This was a matched control study in a porcine model. Five paired simulated stomach lesions 2-2.5 cm in size were removed by H-ESD using an AIO snare or conventional ESD (C-ESD) using an endoscopic knife. The outcomes of the two procedures were compared, including en-bloc resection rates, procedure times, intraprocedural bleeding volumes, muscular injuries, perforations, thicknesses of the submucosal layer in resected specimens, and stomach defects. All simulated lesions were resected en-bloc. Specimens resected by H-ESD and C-ESD were similar in size (7.68 +/- 2.92 vs. 8.42 +/- 2.42 cm(2); P=0.676). H-ESD required a significantly shorter procedure time (13.39 +/- 3.78 vs. 25.99 +/- 4.52 min; P=0.031) and submucosal dissection time (3.99 +/- 1.73 vs. 13.1 +/- 4.58 min; P=0.003) versus C-ESD; H-ESD also yielded a faster dissection speed (241.37 +/- 156.84 vs. 68.56 +/- 28.53 mm(2)/min; P=0.042) and caused fewer intraprocedural bleeding events (0.40 +/- 0.55 vs. 3.40 +/- 1.95 times/per lesion; P=0.016) than C-ESD. The thicknesses of the submucosal layer of the resected specimen (1190.98 +/- 134.07 vs. 1055.90 +/- 151.76 mu m; P=0.174) and the residual submucosal layer of the stomach defect (1607.94 +/- 1026.74 vs. 985.98 +/- 445.58 mu m; P=0.249) were similar with both procedures. The AIO snare is a safe and effective device for H-ESD and improves the treatment outcomes of gastric lesions by shortening the procedure time.