Dig Endosc. 2014 May;26(3):365-8. doi: 10.1111/den.12186.
Endoscopic submucosal dissection (ESD) is a complex procedure and is associated with significant risks. The aims of this pilot study were to study feasibility and procedural times of gastric ESD using a novel gel and endoscopic scissors in a porcine model.
Simulated 3-cm gastric submucosal lesions were created in a porcine model. Subsequently, viscous gel was injected into the created bleb. A needle knife was used to create an initial incision when needed. Endoscopic scissors were then used for circumferential incision around the simulated submucosal lesions. The inserted coil (i.e. submucosal lesion) was then removed. The submucosal surface was carefully examined for signs of injury. Procedural times were recorded.
ESD was carried out in four consecutive pigs using the 'Scissorhands' technique. A small submucosal incision was created a using needle knife in the first pig and electrocautery was not used in the remaining three pigs. Circumferential incision using the scissors was done successfully in all pigs. Submucosal dissection was not required in any case. 'Auto-dissection' of created lesions by the gel was noted to be complete in all cases. Inserted coils were noted in the submucosal space during all experiments and were removed. All lesions were successfully resected en bloc. The mean procedure time was 19 min (range 13-22 min).
The combined technique of endoscopic scissors for circumferential incision and viscous gel for submucosal dissection permitted easy, safe and efficient gastric ESD. Electrocautery may be avoided and its consequent adverse events (e.g. perforation).
内镜黏膜下剥离术（ESD）是一种复杂的手术，存在较大风险。本研究旨在探讨在猪模型中使用新型凝胶和内镜剪刀进行胃 ESD 的可行性和操作时间。
在猪模型中模拟 3cm 的胃黏膜下病变。然后向创建的隆起中注入粘性凝胶。当需要时，使用针形刀创建初始切口。然后使用内镜剪刀围绕模拟黏膜下病变进行环形切口。然后取出插入的线圈（即黏膜下病变）。仔细检查黏膜下表面是否有损伤迹象。记录操作时间。
使用“Scissorhands”技术连续在四只猪中进行了 ESD。第一只猪使用针形刀进行了小的黏膜下切口，其余三只猪未使用电烙术。所有猪均成功完成了剪刀的环形切口。在任何情况下都不需要进行黏膜下剥离。在所有情况下，凝胶均能完全“自动”切开创建的病变。在所有实验中均能在黏膜下间隙看到插入的线圈，并将其取出。所有病变均整块成功切除。平均手术时间为 19 分钟（范围 13-22 分钟）。
内镜剪刀进行环形切口和粘性凝胶进行黏膜下剥离的联合技术可实现安全、高效的胃 ESD。可避免电烙术及其引起的不良事件（如穿孔）。
