Water pressure method for duodenal endoscopic submucosal dissection (with video)

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Medical Device Innovation

Background:

• Duodenal endoscopic submucosal dissection (ESD) presents significant technical challenges and a high risk of adverse events.
• Recent advancements include the water pressure (WP) method and the second-generation DualKnife J with a water jet function.
• These innovations aim to improve the safety and efficiency of duodenal ESD procedures.

Purpose of the Study:

• To evaluate the impact of the water pressure (WP) method and the DualKnife J on clinical outcomes in duodenal ESD.
• To determine if these new techniques and devices reduce intraprocedural perforation rates and procedure times.
• To assess the association between treatment phase and procedural outcomes.

Main Methods:

• Retrospective observational study of patients undergoing duodenal ESD for superficial tumors (June 2010 - December 2018).
• Analysis included the use of the WP method, DualKnife, and DualKnife J, as well as treatment phase (early, mid, late).
• Factors associated with intraprocedural perforation and procedure time were statistically analyzed.

Main Results:

• The late treatment phase showed the lowest intraprocedural perforation rate and shortest procedure time.
• Multivariate analysis confirmed the WP method significantly decreased intraprocedural perforation rates (OR, 0.39).
• Both the WP method and DualKnife J were independently and negatively correlated with procedure time.

Conclusions:

• The WP method is effective in reducing intraprocedural perforation rates during duodenal ESD.
• The combination of the WP method and DualKnife J significantly shortens procedure times.
• These advancements contribute to improved clinical outcomes for duodenal ESD.