Publications

Tillinger W, Reckendorfer H. Der Endorotor® – Ein neues endoskopisches Resektionssystem: Fallbericht // The EndoRotor® – a novel endoscopic device for mucosal resection. A case report. J Gastroen- terol Hepatol Erkr 2017; 15

Knabe M, Blosser S, Ell Christian, Wetzka J, May A. Non-thermal ablation of non-neoplastic Barrett’s esophagus with the novel EndoRotor resection device. UEG Journal. 2018. 0-0 1-6

Duddempudi S, Papafragkakis C, Changela K, Pohl H. Su2038 Feasibility of a New Mucosal Resection Device - the Endorotor™. Gastroenterology April 2015, Volume 148, Issue 4, Supplement 1, Page S-582.

Nantha Surkunalingam, DO, Ananya Das, MD, Farhoud Khosravi, DO, Mankanwal Sachdev, MD. Arizona Centers for Digestive Health, Gilbert, Arizona. USA. Sigmoid colon polyp EMR with novel endoscopic morcellator.

Sophia E. van der Wiel, Jan-Werner Poley, Marina J. A. L. Grubben, Marco J. Bruno, Arjun D. Koch. Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands. The EndoRotor, a novel tool for the endoscopic management of pancreatic necrosis.


Abstracts

Presented at ESGE 2018

Management of scarred Polys: The use of a novel non-diathermic endoscopic mucosal resection device


Authors: K Kandiah, P Bhandari, S Subramaniam
Portsmouth Hospitals NHS Trust, Gastroenterology, Portsmouth, United Kingdom

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Introduction
Benign colonic polyps are traditionally resected via endoscopic mucosal resection (EMR). This technique is safe but carries risk of recurrence of 10 – 15% in polyps larger than 20 mm. Post-EMR recurrences are often scarred making endoscopic management of these polyps challenging with a high risk of complications. EndoRotor® is a novel non-diathermic EMR device designed to reduce diathermy related complications (eg. perforation and delayed bleeding). We present a video demonstrating the use of this device in the management of scarred polyps.

Methods
The non-diathermic device contains a fixed outer cannula and a rotating inner cannula with openings at the end of both cannulas. Polyp tissue is sucked into the openings and dissected without diathermy by the rotating inner cannula. The dissected tissue is transported into a tissue trap as the polyp is resected.

Results
Two cases are shown to demonstrate the device. In Case 1, a 55-year-old female who previously underwent multi-piece EMR for a 50 mm LST-G in the recto-sigmoid junction, had a 10 mm residual tissue overlying a scarred resection base. Lifting solution consisting of gelofusine, indigo carmine and adrenaline was injected around the polyp. Due to scarring, no lift was obtained. EndoRotor was used to successfully resect the polyp without the need for diathermy. In the Case 2, an 81-year-old man who had previously undergone multipiece EMR of a hemi-circumferential LST-G in the recto-sigmoid junction. There was residual polyp on a scarred base that was treated with EndoRotor as in Case 1.

Conclusions
Scarred polyps are challenging to manage endoscopically as the submucosal plane is lost due to fibrosis. This heightens the risk of perforation and delayed bleeding. EndoRotor is a novel device that is able to resect scarred polyps without the use of diathermy.


DDW Abstract
Poster Number TU1440-A

A novel tool for fast and effective endoscopic removal of pancreatic necrosis

Authors: S.E. van der Wiel, J.W. Poley, M.J.A.L. Grubben, M.J. Bruno, A.D. Koch.
Dept. of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Netherlands

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Introduction
Acute pancreatitis may run a severe course when pancreatic necrosis becomes infected. Invasive treatment of these patients is virtually always necessary and over the last decade the treatment has changed dramatically towards less invasive treatments. Endoscopic drainage and ensuing necrosectomy have been shown to be effective in the management of pancreatic necrosis. One of the main limitations during endoscopic management is the lack of suitable instruments to remove necrotic tissue, resulting in time consuming procedures with marginal results and often necessitating multiple procedures. We aimed to evaluate the technical feasibility, safety and clinical outcome of the EndoRotor®, a novel automated mechanical endoscopic resection system to suck, cut and remove small pieces of tissue in patients with necrotizing pancreatitis.

Methods
Subjects with infected walled-off pancreatic necrosis were endoscopically treated using the EndoRotor device. Procedures were performed under conscious or propofol sedation by four endoscopists with a broad experience in advanced endoscopic procedures including conventional endoscopic necrosectomy. Endoscopists were additionally asked to fill out a short questionnaire about their experience using the EndoRotor.

Results
Six patients have been endoscopically treated for pancreatic necrosis, five patients were men and the median age was 61.7 years (range 43-71). Imaging data of the pancreas revealed a mean necrotic collection size of 114.7mm diameter (range 50-180mm). Transgastric drainage was performed in all patients, four patients received plastic stents and two a fully covered lumen apposing stent. Three patients were previously treated unsuccessfully with conventional tools with a median of two procedures (range 1-3). Additionally, the EndoRotor was used in six patients with a total of 16 procedures, the average procedure length was 46.5 minutes (range 32-80). To achieve complete removal of pancreatic necrosis the median number of required procedures was two per patient (range 1-7). No procedure-related adverse events occurred. Endoscopists agree on the ease of use and effective removal of necrotic tissue with the EndoRotor, rating both 8.3 on a 10-point scale. They are especially satisfied by the ability to manage the removal of necrotic tissue in a controlled way (8.6 on a 10-point scale). Moreover, they are convinced that this device is of additional value in the management of pancreatic necrosis (8.6) and are willing to use it again (9.3 on a 10-point scale).

Conclusions
Initial experience with the EndoRotor suggests that this device can safely, quickly and effectively remove pancreatic necrosis.


DDW Abstract
Poster Number Mo1087

The incidence of microscopic residual lesion left after apparent complete wide-field EMR of large colorectal superficial neoplastic lesions: evidence for the pathophysiological mechanism of recurrence

Authors: Andrew Emmanuel, Shraddha Gulati, Monica Ortenzi, Margaret Burt, Bu Hayee, Amyn Haji, Department of Endoscopy, King's College Hospital, London, United Kingdom

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Introduction
Endoscopic mucosal resection (EMR) of large colorectal superficial neoplastic lesions (CSNL) is associated with significant recurrence and the risk of recurrence is significantly higher with piecemeal EMR (pEMR). The mechanism for this has not been proven but it has been postulated that recurrence occurs as a result of microscopic areas of residual adenoma left behind between areas of sequential snare capture during pEMR 1 We aimed to determine the incidence of residual microadenoma in apparently normal mucosa left at the margin of the defect following EMR of large CSNL.

Methods
Following EMR and pEMR of 31 large CSNL performed at a tertiary referral centre, the base and margin of the resulting defect were carefully examined with magnification chromoendoscopy and NBI/BLI to ensure complete resection with no residual adenoma. The apparently normal mucosa at the defect margin was then resected using the EndoRotor® device, allowing the full extent of the margin of the defect to be removed and sampled. Areas of submucosal fibrosis or diathermy artefact at the base were also sampled if present. Data on the lesion characteristics, resection technique, number of pieces for pEMR, histopathology findings of the lesion and the mucosa at the margin were collected.

Results
Mean lesion size was 46.7mm (range 32mm-130mm). Mucosa at the defect margin was sampled in all cases and 100% of the margin was achieved in 28 (90%). Final histopathology of resected lesions was adenoma in 27 (87%), serrated adenoma in 2 (6%) and adenocarcinoma in 2. Microscopic residual lesion was detected in the margin of apparently normal mucosa in 4 cases (13%). In 3 cases this was adenoma with low grade dysplasia and in one case a serrated lesion with no dysplasia was found in at the margin of a resected tubular adenoma. Microscopic residual lesion was detected in the base in 4 cases: 1 was microadenoma, 2 were serrated lesions without dysplasia in the base of resected adenomas and 1 was residual adenocarcinoma. There was no association with pEMR in >3pieces and residual microscopic lesion or pEMR ≤3 pieces (OR 0.89, 95% CI 0.16-4.8, p=0.89). There were no complications.

Conclusions
To our knowledge, this is the first series examining the findings after continuous sampling of the full circumferential margin of apparently normal mucosa left at the defect after EMR of large CSNL. Despite examination with magnification suggesting complete resection, microscopic residual lesion at the margin was present in 13%. This study provides evidence that microscopic residual lesion left after EMR underlies the pathophysiology of recurrence and lends support for techniques that continuously resect or ablate the circumferential margin of the defect to reduce recurrence.