Efficacy and safety of a multi-degree-of-freedom articulating forceps for endoscopic submucosal dissection and closure of large mucosal defects in a porcine model

Background and Aims: Multi-degree-of-freedom (MDOF) articulating forceps for flexible endoscopy feature a unique device combining rotating and bending articulation to provide active traction. This study aimed to evaluate the efficacy and safety of the MDOF articulating forceps for endoscopic submucosal dissection (ESD) and closure of large post-ESD mucosal defects using a linearized closure technique. Methods: Four rectal sites (20-50 mm) and 3 gastric sites (20-40 mm) were resected in explanted porcine models. ESD was performed by applying active traction of the articulating forceps to the mucosal flap. After ESD, the articulating forceps were used for defect closure by grasping an edge of the mucosal defect and pulling it toward the luminal cavity, allowing submucosal tissue apposition within the defect and configuration of the linear defect for easy through-the-scope clip closure. Results: The mean procedure times of the gastric and rectal ESD were 16.1 ± 8.7 minutes and 20.7 ± 4.3 minutes, respectively. The mean sizes of the post-ESD gastric and rectal mucosal defects were 38.0 ± 12.6 mm and 43.8 ± 10.2 mm. No injury to the muscularis propria or perforations occurred. Complete clip closure was achieved in all mucosal defects. The mean procedure time for defect closure was 29.3 ± 5.4 minutes in the stomach and 15.5 ± 5.2 minutes in the rectum. The mean combined procedure times for ESD and clip closure were 45.4 ± 13.5 minutes in the stomach and 36.3 ± 7.9 minutes in the rectum. Conclusions: The MDOF articulating forceps seem to be an effective and safe adjunct traction tool for ESD and closure of large mucosal defects. Future clinical studies are needed to validate the efficiency, safety, and durability of this approach.