ASGE JGES Advanced ESD | September 2022-Bhatt New methods techniques and technologies for ESD

Bhatt New methods techniques and technologies for ESD

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Amit Bhatt, the Director of ESD at Cleveland Clinic, discusses the limitations of Endoscopic Submucosal Dissection (ESD). ESD lacks the surgical principles of triangulation and is performed through only one arm using an endoscope, as noted in a study by Norio Fukami. Homemade traction solutions, such as the clip + line method, have shown some benefit within the esophagus, but they have limitations and are not useful in all cases.<br /><br />Bhatt talks about his journey of learning about ESD in Japan under the mentorship of Dr. Yutaka Saito. Together with Medtronic Gastrointestinal, Bhatt and his team developed a device called ProdiGI™ traction wire, which provides continuous counter traction and is simple to use. The device, initially a prototype, was later refined into a single nitinol wire that is curved in its natural state and can be deployed through the scope, allowing for a flexible endoscope position.<br /><br />Bhatt also mentions the success of using the ProdiGI™ traction wire in assisting ESD in the colon. In a study conducted at multiple centers, the efficacy, safety, and efficiency of the traction wire (TW-ESD) were assessed. The study found a high en bloc resection rate of 98.1% and a median deployment time of 2 minutes.<br /><br />Bhatt concludes by mentioning the benefits of the ProdiGI™ traction wire, such as reducing knife exchange and cost in ESD procedures. However, the device currently does not have injection capability.<br /><br />Overall, Bhatt highlights the limitations of ESD and the advancements made in developing a traction wire device that improves the effectiveness and efficiency of the procedure.

Keywords

Amit Bhatt

ESD limitations

triangulation

homemade traction solutions

ProdiGI™ traction wire

continuous counter traction

efficacy

safety

efficiency

cost reduction