Endoscopic submucosal dissection knives for the removal of gastrointestinal lesions

Status:

In progress

Technology type:

Device

Decision:

Selected

Reason for decision:

Anticipate the topic will be of importance to patients, carers, professionals, commissioners and the health of the public to ensure clinical benefit is realised, inequalities in use addressed, and help them make the best use of NHS resources

Description:

Gastrointestinal lesions are growths on the lining of the gastrointestinal tract that can be cancerous or develop into cancers. Colorectal cancer is one of the most common cancers in the UK and is the second most common cause of cancer death. Around 40,000 new cases of colorectal cancer are registered each year. Current practice is to remove lesions as they are identified. Flat lesions are typically removed using endoscopic mucosal resection which involves the injection of fluid underneath the lesion, raising it away from the gastrointestinal wall to allow removal with a snare. Endoscopic mucosal resection carries a risk of perforation, especially in the colon where the gastrointestinal wall is particularly thin. It may also not fully remove the lesion, leaving potential for the lesion to regrow, potentially accelerating the spread of cancerous cells, and making assessment of biopsies for cancer less accurate. Endoscopic submucosal dissection is a modification of endoscopic mucosal resection that uses an electrical knife to remove the lesion in one piece. Similarly to endoscopic mucosal resection, endoscopic submucosal dissection involves injection of fluid beneath the lesion to protrude it away from the gastrointestinal wall. The knife is used to cut around the base of the lesion, allowing the lesion to be removed in 1 piece under direct visualisation from an integrated endoscope. By removing the lesion in 1 piece, endoscopic submucosal dissection may reduce regrowth and allow for more accurate cancer assessment, potentially improving outcomes for patients.

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