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De-la-Peña J, Calderón Á, Esteban JM, López-Rosés L, Martínez-Ares D, Nogales Ó et al. Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country. Rev Esp Enferm Dig. 2014 Feb;106(2):98-102.

PMID: 24852735

Contiene 19 referencias

Background: Endoscopic submucosal dissection (ESD) is an
effective but time-consuming treatment for early neoplasia that
requires a high level of expertise.
Objective: The objective of this study was to assess the efficacy and learning curve of gastric ESD with a hybrid knife with highpressure water jet and to compare with standard ESD.
Material and methods: We performed a prospective nonsurvival animal study comparing hybrid-knife and standard gastric ESD. Variables recorded were: Number of en-bloc ESD, number of ESD with all marks included (R0), size of specimens, time and speed of dissection and adverse events. Ten endoscopists performed a total of 50 gastric ESD (30 hybrid-knife and 20 standard).
Results: Forty-six (92 %) ESD were en-bloc and 25 (50 %) R0
(hybrid-knife: n = 13, 44 %; standard: n = 16, 80 %; p = 0.04).
Hybrid-knife ESD was faster than standard (time: 44.6 ± 21.4 minutes vs. 68.7 ± 33.5 minutes; p = 0.009 and velocity: 20.8 ± 9.2 mm2/min vs. 14.3 ± 9.3 mm2/min (p = 0.079). Adverse events were not different. There was no change in speed with any of two techniques (hybrid-knife: From 20.33 ± 15.68 to 28.18 ± 20.07 mm2/min; p= 0.615 and standard: From 6.4 ± 0.3 to 19.48 ± 19.21 mm2/min; p = 0.607). The learning curve showed a significant improvement in R0 rate in the hybrid-knife group (from 30 % to 100 %).
Conclusion: despite the initial performance of hybrid-knife
ESD is worse than standard ESD, the learning curve with hybridknife ESD is short and is associated with a rapid improvement. The introduction of new tools to facilitate ESD should be implemented with caution in order to avoid a negative impact on the results.