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Endoscopic submucosal dissection of large polyps in the right colon using an endoscopic snare with a double-balloon endolumenal interventional platform: an ex vivo study in a porcine colorectal model

  • 2020 SAGES Oral
  • Published:
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Abstract

Background

Endoscopic submucosal dissection (ESD) is a challenging procedure for the removal of colorectal tumors, especially tumors located in the right colon. The use of traction could make this procedure technically easier and reduce procedure times and complication rates. In this study, we demonstrated the feasibility and utility of a traction technique utilizing an endoscopic snare through an overtube, a double-balloon endolumenal interventional platform (DEIP) in a porcine colorectal model.

Methods

A total of 120 procedures were performed using three different techniques: standard ESD technique (STD), ESD with DEIP (DEIP alone), and ESD with DEIP and a snare (DEIP + Snare). The snare was passed inside the overtube and used as a grasper on the tissue to provide traction. Lesions 3 or 4 cm in diameter were removed with a 5 mm margin from the anterior and posterior walls of the proximal Transverse Colon, the Hepatic Flexure, and the posterior wall of the Cecum. The outcomes measured included procedure times and the number of muscularis propria injuries.

Results

The DEIP + Snare group showed significantly shorter total procedure and submucosal dissection times for lesions in all locations (median 28.1 min (DEIP + Snare, n = 32) vs 39.8 (STD, n = 32) vs 39.7 (DEIP alone, n = 32); 7.5 min vs 25.3 vs 25.1) and had fewer muscularis propria injuries (median 0 [range 0–2] vs 2 [0–7] vs 1 [0–6]) than the two other groups. Larger lesions (4 cm) were successfully removed by regrasping the tissue in DEIP + Snare group, which showed significantly shorter total procedure time [31.4 min (DEIP + Snare, n = 8) vs 40.1 (STD, n = 8) vs 45.6 (DEIP alone, n = 8)] and submucosal dissection time (12.3 min vs 27.6 vs 29.1) than the two other groups.

Conclusions

ESD traction technique with an endolumenal platform and snare enables faster removal of large polyps in the right colon with fewer injuries than standard methods of ESD.

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Abbreviations

AB:

Aft-Balloon

DEIP:

Double-balloon endolumenal interventional platform

ESD:

Endoscopic submucosal dissection

EMR:

Endoscopic mucosal resection

FB:

ForeBalloon

STD:

Standard Cap-assisted ESD technique

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Acknowledgements

The authors thank Drs. Krishna C. Gurram and Makoto Nishimura for their assistance during the conduct of this study.

Funding

This study was funded, in part, through a research grant from Lumendi Ltd, Westport, CT, USA.

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Authors and Affiliations

  1. Department of Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, 525 East 68th Street, K-801, New York, NY, 10065, USA

    Shinya Urakawa, Kota Momose, Teijiro Hirashita, Lea Lowenfeld & Jeffrey W. Milsom

  2. Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan

    Kota Momose

Authors
  1. Shinya Urakawa
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  2. Kota Momose
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  3. Teijiro Hirashita
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  4. Lea Lowenfeld
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  5. Jeffrey W. Milsom
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Corresponding author

Correspondence to Jeffrey W. Milsom.

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Disclosures

Dr. Milsom is on the clinical advisory board of Lumendi. Drs. Urakawa, Momose, Hirashita, and Lowenfeld have no conflicts of interest or financial ties to disclose.

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Urakawa, S., Momose, K., Hirashita, T. et al. Endoscopic submucosal dissection of large polyps in the right colon using an endoscopic snare with a double-balloon endolumenal interventional platform: an ex vivo study in a porcine colorectal model. Surg Endosc 35, 6319–6328 (2021). https://doi.org/10.1007/s00464-020-08100-7

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  • DOI: https://doi.org/10.1007/s00464-020-08100-7

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