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Efficacy of early clip-with-line method for colorectal endoscopic submucosal dissection

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Abstract

Background

Colorectal endoscopic submucosal dissection (ESD) remains demanding due to technical difficulties and high risk of perforation. Most of the reported traction methods are initiated after creating a mucosal flap, which is time consuming. To obtain a good visualization at the mucosal incision stage, we developed the early clip-with-line (ECL) method. This method was started immediately after injection of sodium hyaluronate solution into the submucosal layer. In this study, we evaluated the efficacy and the safety of the ECL method for colorectal ESD.

Methods

We retrospectively analyzed all cases of colorectal ESDs (41 cases in total) performed from January 2017 to February 2019 in our institution. From January 2017 to August 2018, 27 of these cases were performed using conventional (non-ECL) ESDs, while from September 2018 onwards, the remaining 14 cases were performed using the ECL method. Retrospective comparison between the ECL group and the non-ECL group was conducted in terms of clinical characteristics, treatment outcomes, and adverse events.

Results

There were no significant differences in clinical characteristics between two groups. Procedure time (median [range]) was significantly shorter in the ECL group than in the non-ECL group (66 [29–131] min vs 90 [30–410] min; P = 0.03). As for adverse events, no case of perforation occurred in the ECL group, whereas perforation was observed in 7.4% (2/27) cases in the non-ECL group (no significant difference).

Conclusion

Early clip-with-line method for colorectal endoscopic submucosal dissection reduced procedure time.

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Authors and Affiliations

  1. Department of Gastroenterology, Chiba Kaihin Municipal Hospital, 3-31-1 Isobe, Mihama-ku, Chiba, Japan

    Hideyuki Takashiro, Hirofumi Saito, Katsunobu Tawada, Yuhei Oyama, Shinichi Tazawa, Masatoshi Usui, Hiromasa Nomoto & Kazuhiko Kita

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  1. Hideyuki Takashiro
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  2. Hirofumi Saito
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  3. Katsunobu Tawada
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  4. Yuhei Oyama
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  5. Shinichi Tazawa
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  6. Masatoshi Usui
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  7. Hiromasa Nomoto
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  8. Kazuhiko Kita
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Corresponding author

Correspondence to Hideyuki Takashiro.

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Hideyuki Takashiro, Hirofumi Saito, Katsunobu Tawada, Yuhei Oyama, Shinichi Tazawa, Masatoshi Usui, Hiromasa Nomoto, and Kazuhiko Kita have no conflicts of interest or financial ties to disclose.

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Video 1: Early clip-with-line method for colorectal endoscopic submucosal dissection. Prior to the procedure, the following preparations are made. First, a long nylon line is inserted into the accessory channel of the scope. The end of the line coming out of the accessory channel is tied to a ZEOCLIP and fixed on the scope with tape. Another end of the line is grasped with light Pean forceps. Next, the scope is inserted. A large (40mm) granular laterally spreading tumor is located in the transverse colon. Hyaluronic acid solution is then injected into the submucosal layer at the anal side of the lesion. The tape fixing the ZEOCLIP is removed, and a ZEOCLIP delivery catheter attaching the ZEOCLIP with line is inserted into the accessory channel. The ZEOCLIP grasp the injected part next to the anal edge of the lesion and the line is pulled gently. A mucosal incision is started from the anal side of the ZEOCLIP. The submucosa to be dissected was widely opened and clearly observed from the beginning to the end of the procedure, and the lesion is easily dissected (wmv 105405 kb)

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Takashiro, H., Saito, H., Tawada, K. et al. Efficacy of early clip-with-line method for colorectal endoscopic submucosal dissection. Surg Endosc 36, 321–327 (2022). https://doi.org/10.1007/s00464-020-08280-2

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  • DOI: https://doi.org/10.1007/s00464-020-08280-2

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