Skip to main content

Advertisement

SpringerLink
Log in

Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S–O clip

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endoscopic submucosal dissection (ESD) allows en bloc resection of superficial colorectal tumors regardless of size. However, ESD is technically difficult, hazardous, and time consuming. New devices may help overcome these drawbacks. We focused on traction methods and designed a new traction device, the “S–O clip.” Its main advantage is that it allows direct visualization of the cutting line during submucosal dissection. Moreover, it can be used at any location without withdrawing the endoscope. The purpose of this study was to evaluate the efficacy and safety of traction device-assisted ESD for large colorectal tumors using the S–O clip.

Methods

Between August 2010 and December 2011, ESD was performed in 70 patients with a superficial colorectal tumor ≥20 mm in diameter in our department. Patients were randomized into two groups: 27 cases in the S–O clip-assisted ESD group and 23 cases in the conventional ESD group. Included in the analysis were patient’s gender and age, tumor form, size, and location, rate of en bloc resection, procedure time, presence or absence of intraoperative perforation or delayed bleeding, and pathological findings. Subgroup analysis stratified by these factors and multivariate analyses were conducted.

Results

In the S–O clip-assisted ESD group, all 27 tumors were resected en bloc without any complications. Although a micro perforation occurred in one patient in the conventional ESD group, further surgical treatment was not required. None of the other 22 cases in the conventional ESD group experienced complications. The mean procedure time for the S–O clip-assisted ESD group was significantly shorter than for the conventional ESD group (37.4 ± 32.6 vs. 67.1 ± 44.1 min, p = 0.03). No significant between-group differences were found for the other factors.

Conclusion

Our results demonstrated that S–O clip-assisted ESD is safe and fast for en bloc resection of large superficial colorectal tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Conio M, Ponchon T, Blanchi S, Filiberti R (2006) Endoscopic mucosal resection. Am J Gastroenterol 101:653–663

    Article  PubMed  Google Scholar 

  2. Fujiya M, Moriichi K, Saitoh Y, Watari J, Kohgo Y (2009) Endoscopic piecemeal resection is a practical option to cure colorectal tumors. Dig Endosc 21(Suppl 1):S28–S30

    Article  PubMed  Google Scholar 

  3. Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461

    Article  PubMed  CAS  Google Scholar 

  4. Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu KI, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352

    Article  PubMed  Google Scholar 

  5. Fujishiro M (2006) Endoscopic submucosal dissection for stomach neoplasms. World J Gastroenterol 12:5108–5112

    PubMed  PubMed Central  Google Scholar 

  6. Imagawa A, Okada H, Kawahara Y, Takenaka R, Kato J, Kawamoto H, Fujiki S, Takata R, Yoshino T, Shiratori Y (2006) Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy 38:987–990

    Article  PubMed  CAS  Google Scholar 

  7. Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226

    Article  PubMed  CAS  Google Scholar 

  8. Onozato Y, Ishihara H, Iizuka H, Sohara N, Kakizaki S, Okamura S, Mori M (2006) Endoscopic submucosal dissection for early gastric cancers and large flat adenomas. Endoscopy 38:980–986

    Article  PubMed  CAS  Google Scholar 

  9. Cao Y, Liao C, Tan A, Gao Y, Mo Z, Gao F (2009) Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract. Endoscopy 41:751–757

    Article  PubMed  CAS  Google Scholar 

  10. Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107

    Article  PubMed  Google Scholar 

  11. Lee EJ, Lee JB, Choi YS, Lee SH, Lee DH, Kim do S, Youk EG (2012) Clinical risk factors for perforation during endoscopic submucosal dissection (ESD) for large-sized, nonpedunculated colorectal tumors. Surg Endosc 26:1587–1594

    Article  PubMed  Google Scholar 

  12. Imaeda H, Hosoe N, Ida Y, Kashiwagi K, Morohoshi Y, Suganuma K, Nagakubo S, Komatsu K, Suzuki H, Saito Y, Aiura K, Ogata H, Iwao Y, Kumai K, Kitagawa Y, Hibi T (2009) Novel technique of endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia. Dig Endosc 21:122–127

    Article  PubMed  Google Scholar 

  13. Neuhaus H, Costamagna G, Deviere J, Fockens P, Ponchon T, Rosch T (2006) Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy 38:1016–1023

    Article  PubMed  CAS  Google Scholar 

  14. Saito Y, Emura F, Matsuda T, Uraoka T, Nakajima T, Ikematsu H, Gotoda T, Saito D, Fujii T (2005) A new sinker-assisted endoscopic submucosal dissection for colorectal cancer. Gastrointest Endosc 62:297–301

    Article  PubMed  Google Scholar 

  15. Kondo H, Gotoda T, Ono H, Oda I, Kozu T, Fujishiro M, Saito D, Yoshida S (2004) Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer. Gastrointest Endosc 59:284–288

    Article  PubMed  Google Scholar 

  16. Uraoka T, Ishikawa S, Kato J, Higashi R, Suzuki H, Kaji E, Kuriyama M, Saito S, Akita M, Hori K, Harada K, Ishiyama S, Shiode J, Kawahara Y, Yamamoto K (2010) Advantages of using thin endoscope-assisted endoscopic submucosal dissection technique for large colorectal tumors. Dig Endosc 22:186–191

    Article  PubMed  Google Scholar 

  17. Gotoda T, Oda I, Tamakawa K, Ueda H, Kobayashi T, Kakizoe T (2009) Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest Endosc 69:10–15

    Article  PubMed  Google Scholar 

  18. Sakamoto N, Osada T, Shibuya T, Beppu K, Matsumoto K, Mori H, Kawabe M, Nagahara A, Otaka M, Ogihara T, Watanabe S (2009) Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S–O clip for traction (with video). Gastrointest Endosc 69:1370–1374

    Article  PubMed  Google Scholar 

  19. Sakamoto N, Osada T, Shibuya T, Beppu K, Matsumoto K, Shimada Y, Konno A, Kurosawa A, Nagahara A, Ohkusa T, Ogihara T, Watanabe S (2008) The facilitation of a new traction device (S–O clip) assisting endoscopic submucosal dissection for superficial colorectal neoplasms. Endoscopy 40(Suppl 2):E94–E95

    Article  PubMed  Google Scholar 

  20. Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E (2001) Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy 33:367–373

    Article  PubMed  CAS  Google Scholar 

  21. Sano Y, Ikematsu H, Fu KI, Emura F, Katagiri A, Horimatsu T, Kaneko K, Soetikno R, Yoshida S (2009) Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 69:278–283

    Article  PubMed  Google Scholar 

  22. Lee EJ, Lee JB, Lee SH, Kim do S, Lee DH, Lee DS, Youk EG (2013) Endoscopic submucosal dissection for colorectal tumors—1,000 colorectal ESD cases: one specialized institute’s experiences. Surg Endosc 27:31–39

    Article  PubMed  Google Scholar 

  23. Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, Yoshida S, Ikehara H, Otake Y, Nakajima T, Matsuda T, Saito D (2010) A prospective, multicenter study of 1,111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225

    Article  PubMed  Google Scholar 

  24. Saito Y, Kawano H, Takeuchi Y, Ohata K, Oka S, Hotta K, Okamoto K, Homma K, Uraoka T, Hisabe T, Chang DK, Zhou PH (2012) Current status of colorectal endoscopic submucosal dissection in Japan and other Asian countries: progressing towards technical standardization. Dig Endosc 24(Suppl 1):67–72

    Article  PubMed  Google Scholar 

  25. Mannen K, Tsunada S, Hara M, Yamaguchi K, Sakata Y, Fujise T, Noda T, Shimoda R, Sakata H, Ogata S, Iwakiri R, Fujimoto K (2010) Risk factors for complications of endoscopic submucosal dissection in gastric tumors: analysis of 478 lesions. J Gastroenterol 45:30–36

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported in part by Grant-in-Aid for Scientific Research (C) (No. 23591023 to T.O. and N.S.) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Disclosures

Hideaki Ritsuno, Naoto Sakamoto, Taro Osada, Shingo P. Goto, Takashi Murakami, Hiroya Ueyama, Hiroki Mori, Kenshi Matsumoto, Kazuko Beppu, Tomoyoshi Shibuya, Akihito Nagahara, Tatsuo Ogihara, Sumio Watanabe have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Hideaki Ritsuno, Naoto Sakamoto, Taro Osada, Shingo P. Goto, Takashi Murakami, Hiroya Ueyama, Hiroki Mori, Kenshi Matsumoto, Kazuko Beppu, Tomoyoshi Shibuya, Akihito Nagahara, Tatsuo Ogihara & Sumio Watanabe

Authors
  1. Hideaki Ritsuno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoto Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Taro Osada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shingo P. Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroya Ueyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroki Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kenshi Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kazuko Beppu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tomoyoshi Shibuya
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Akihito Nagahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tatsuo Ogihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Sumio Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naoto Sakamoto.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ritsuno, H., Sakamoto, N., Osada, T. et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S–O clip. Surg Endosc 28, 3143–3149 (2014). https://doi.org/10.1007/s00464-014-3572-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3572-0

Keywords

Search

Navigation