Transanal endoscopic microsurgical submucosal dissection: Are there advantages over conventional ESD?

[INTRODUCTION] Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) is a technique that has been recently described for the treatment of large rectal adenomas and early rectal cancer. The purpose of our study is to compare TEM-ESD with flexible endoscopic submucosal dissection (ESD) in an experimental, porcine model.

[MATERIAL AND METHODS] We used TEM-ESD and flexible ESD to resect a total of 100 standardized 4 × 4cm lesions in an porcine stomach model, performing 50 resections with each technique. Total procedure time, en bloc resection rate, injuries of the muscularis propria, perforation rate and learning curve were analysed.

[RESULTS] TEM-ESD was associated with a significantly shorter total procedure time in comparison to ESD (19 min vs. 33 min,  < .001). The rates of en bloc resection, injury of the muscularis propria layer, and perforation were the same in both groups. The learning curve of TEM-ESD was shallower than that of ESD.

[CONCLUSION] TEM-ESD showed an advantage over ESD in terms of procedure time and learning curve, with similar en bloc resection rates and safety profile in our experimental model.