Histopathological effects of electrosurgical interventions in an in vivo porcine model of colonic endoscopic mucosal resection.

Autor:	Whitfield AM; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.; Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia., Burgess NG; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.; Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia., Bahin FF; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.; Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia., Kabir S; Department of General Surgery, Westmead Hospital, Westmead, New South Wales, Australia., Pellisé M; Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain., Sonson R; Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia., Subramanian V; Department of General Surgery, Westmead Hospital, Westmead, New South Wales, Australia., Mahajan H; Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia., McLeod D; Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, New South Wales, Australia., Byth K; NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.; WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia., Bourke MJ; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia michael@citywestgastro.com.au.; Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia.
Jazyk:	angličtina
Zdroj:	Gut [Gut] 2022 May; Vol. 71 (5), pp. 864-870. Date of Electronic Publication: 2021 Jun 25.
DOI:	10.1136/gutjnl-2021-324140
Abstrakt:	Objective: Endoscopic mucosal resection (EMR) in the colon has been widely adopted, but there is limited data on the histopathological effects of the differing electrosurgical currents (ESCs) used. We used an in vivo porcine model to compare the tissue effects of ESCs for snare resection and adjuvant margin ablation techniques. Design: Standardised EMR was performed by a single endoscopist in 12 pigs. Two intersecting 15 mm snare resections were performed. Resections were randomised 1:1 using either a microprocessor-controlled current (MCC) or low-power coagulating current (LPCC). The lateral margins of each defect were treated with either argon plasma coagulation (APC) or snare tip soft coagulation (STSC). Colons were surgically removed at 72 hours. Two specialist pathologists blinded to the intervention assessed the specimens. Results: 88 defects were analysed (median 7 per pig, median defect size 29×17 mm). For snare ESC effects, 156 tissue sections were assessed. LPCC was comparable to MCC for deep involvement of the colon wall. For margin ablation, 172 tissue sections were assessed. APC was comparable to STSC for deep involvement of the colon wall. Islands of preserved mucosa at the coagulated margin were more likely with APC compared with STSC (16% vs 5%, p=0.010). Conclusion: For snare resection, MCC and LPCC did not produce significantly different tissue effects. The submucosal injectate may protect the underlying tissue, and technique may more strongly dictate the depth and extent of final injury. For margin ablation, APC was less uniform and complete compared with STSC. Competing Interests: Competing interests: MJB received research support from Olympus Medical, Cook Medical and Boston Scientific. (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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