Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos).
BACKGROUND
Endoscopic submucosal dissection (ESD) enables direct submucosal dissection so even large early stage GI tumors can be resected en bloc. Colorectal ESD is technically more difficult, however, and there is an increased risk of complications such as perforation and bleeding compared with gastric ESD. As a result, further refinements are required in this procedure.


OBJECTIVE
Our purpose was to evaluate thin endoscope-assisted (TEA) ESD, a new traction system for improving submucosal cutting line visualization.


METHODS
Case series.


METHODS
Okayama University Hospital.


METHODS
Efficacy and safety of the TEA-ESD procedure.


RESULTS
Three cases of large, flat, elevated colorectal tumors (laterally spreading tumors) in the rectum and rectosigmoid colon were safely and successfully removed en bloc without complications. Total procedure times were 3 hours, 40 minutes, and 30 minutes with resected specimens measuring 70 x 68 mm, 38 x 35 mm, and 30 x 20 mm, respectively.


CONCLUSIONS
TEA-ESD was performed in only the rectum and rectosigmoid colon.


CONCLUSIONS
This limited case series demonstrated that large laterally spreading tumors in the rectum and rectosigmoid colon could be safely resected en bloc with TEA-ESD.
Uraoka
Toshio
T
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
Kato
Jun
J
Ishikawa
Shin
S
Harada
Keita
K
Kuriyama
Motoaki
M
Takemoto
Koji
K
Kawahara
Yoshiro
Y
Saito
Yutaka
Y
Okada
Hiroyuki
H
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D017115:Catheter Ablation / Q000295:instrumentation*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged