Surgical Endoscopy

, Volume 34, Issue 2, pp 1006–1011 | Cite as

Endoscope rotating technique is useful for difficult colorectal endoscopic submucosal dissection

  • Chao-Wen HsuEmail author
  • Chih-Chien Wu
  • Min-Hung Lee
  • Jui-Ho Wang
  • Yu-Hsun Chen
  • Min-Chi Chang
Dynamic Manuscript



Conventional lesion-up colorectal ESD has the potential risk of iatrogenic perforation due to the knife’s direction toward the muscular layer of the bowel wall. If we rotate the endoscope to the proper position, the mucosal flap is easy to be lifted down by tip attachment and the knife is easy to approach the proper dissection plane, which may prevent the perforation and facilitate difficult ESD.


We aimed to retrospectively assess the safety and efficacy of this rotating technique compared with the conventional lesion-up dissection regardless of shape, location, or size of the tumor, and investigated in short- and long-term outcomes following the ESD procedure.


41 lesions were enrolled into rotating technique group and 37 lesions in lesion-up group. The dissection speed was significantly faster in the rotating technique group (p = 0.023). R0 resection rate was significantly higher in rotating technique group (p = 0.008). The rate of perioperative complication was significantly higher in lesion-up method group (p = 0.003). Local recurrence was higher in lesion-up group (p = 0.001). Recurrence-free rate was higher in rotating technique group (p = 0.018).


The endoscope rotating is a useful technique for difficult colorectal ESD due to easy approaching the proper dissection plane. This technique also increases the rate of en bloc resections, R0 resections regardless of size, shape, and location and improves dissection speed without increasing the incidence of adverse events.


Colorectal Endoscopic submucosal dissection Rotating technique 


Compliance with ethical standards


Chao-Wen Hsu, Chih-Chien Wu, Min-Hung Lee, Jui-Ho Wang, Yu-Hsun Chen, and Min-Chi Chang have no conflicts of interest of financial ties to disclose.

Supplementary material

Supplementary material 1 (MP4 104574 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Chao-Wen Hsu
    • 1
    • 2
    Email author
  • Chih-Chien Wu
    • 1
  • Min-Hung Lee
    • 1
  • Jui-Ho Wang
    • 1
  • Yu-Hsun Chen
    • 2
  • Min-Chi Chang
    • 1
  1. 1.Division of Colorectal SurgeryKaohsiung Veteran General HospitalKaohsiungTaiwan, ROC
  2. 2.Faculty of MedicineNational Yang-Ming UniversityTaipei CityTaiwan, ROC

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