Is it time for Cold-Endoscopic Submucosal Dissection? A feasibility study in an esophageal and colorectal live porcine model

Background and study aims Use of cold endoscopic resection has increased due to excellent results with it and the ability to avoid electrosurgery related complications. The aim of this study was to evaluate the feasibility and safety of cold-endoscopic submucosal dissection (C-ESD) in an in vivo porcine model. Patients and methods C-ESD with circumferential incision and submucosal dissection with a predominantly cold technique was tested in the esophagus and colorectum. Incision and dissection were attempted with a cold technique with a biopsy forceps and an endoscopic Maryland dissector. Large vessels were pre-coagulated with the latter device. Different traction methods were applied. Results Twelve dissections were performed: four esophageal, four colonic, and four rectal. Tunnel and pocket methods were applied successfully. Full C-ESD was possible in the colorectum. In the esophagus, an initial incision had to be done with electrocautery. No major bleeding occurred. Two perforations occurred in the colon, one was endoscopically treated. Conclusions Full C-ESD is feasible in the colorectum, whereas a small hot incision is needed in the esophagus. However, in 50 % of the colonic cases, there were perforations caused by the biopsy forceps making the circumferential incision. Therefore, potential benefits of endoscopic resection without cautery would warrant futures studies in humans initially in esophagus and rectal locations.