3D-Printed Distal Caps for ESD: Clinical and Translational Gastroenterology | May 2026
Conventional Method
Commercial distal attachment caps are routinely used during Endoscopic Submucosal Dissection to improve visualization, tissue traction, and procedural stability. Although effective, these caps are commercially manufactured, relatively costly, and offer limited customization for operator preference or lesion characteristics.
Why a New Method Was Required
As ESD expands globally, especially into resource-limited settings and training programs, there is growing interest in affordable and customizable accessories. The challenge has been whether low-cost 3D-printed devices can match the safety, efficiency, and ergonomics of standard commercial caps without compromising procedural outcomes.
New Method
The ENDOPRINT trial evaluated a custom 3D-printed distal cap made from flexible medical-grade resin against a standard commercial Olympus cap in an ex vivo multicenter porcine ESD model. Ninety-nine ESD procedures across centers in Prague, Olomouc, and Boston were randomized between the two devices.
The study demonstrated identical median procedure times between both caps, with 100% en bloc resection and technical success rates in both groups. Importantly, operators consistently rated the 3D-printed cap superior for visibility, scope manipulation, and tissue retraction. Adverse events were uncommon and similar between groups.
Clinical Utility
This study suggests that 3D-printed caps may provide a safe, effective, and substantially lower-cost alternative to commercial ESD caps. The ability to customize cap design could improve ergonomics and procedural flexibility, particularly for training environments and advanced therapeutic endoscopy units.
Although the study was ex vivo, the results support future in vivo evaluation and cost-effectiveness studies. If validated clinically, customizable 3D-printed accessories may represent an important step toward more accessible and personalized ESD practice worldwide
