A Novel Fixation Method for Variable-Sized Endoscopic Submucosal Dissection Specimens: An In Vitro Animal Experiment

BACKGROUND: Endoscopic submucosal dissection is considered a curative and minimally invasive treatment for early gastric cancer; however, precise pathologic assessment of resected specimens is required to develop further treatment plans. Human error during specimen handling can affect objective assessment of resected specimens. In this study, we investigated whether a novel tissue fixation device offered more objective and standardized pathologic evaluation than conventional manual tissue fixation. METHODS: We developed a novel tissue fixation device for endoscopic submucosal dissection specimens. Two circular tissue samples 2, 3, and 4 cm in diameter were obtained from the body of 45 porcine stomachs. One specimen sample was placed in a fixation device; the other was manually fixed on corkboard. We used a pressure indicator to ensure constant pressure in the resected specimens in the fixation device. We measured submucosal diameter and thickness after 24 hr. RESULTS: The diameters for 2, 3, and 4 cm resected tissue samples were 23.85, 32.30, and 45.0 mm and 21.0, 32.0, and 44.50 mm for the fixation device and manual pinning groups, respectively. The submucosal thicknesses in the fixation device group were 397.09, 381.43, and 415.51 μm and 393.76, 529.69, and 603.82 μm by manual pinning for 2, 3, and 4 cm tissue samples, respectively. Analysis of standard deviation revealed that the submucosal thickness in the manual fixation group was much more variable than in the fixation device group (p = 0.012, 0.042, and 0.001 for 2, 3, and 4 cm tissue specimens, respectively; Fligner-Killeen test of homogeneity of variances). CONCLUSIONS: Among variously sized resected tissue specimens, submucosal thicknesses were more variable in the conventional fixation group, while the thicknesses were comparatively consistent in the fixation device group. After endoscopic submucosal dissection, pathologic preparation using this fixation device could offer more objective assessment of specimens.