Advantages of using thin endoscope-assisted endoscopic submucosal dissection technique for large colorectal tumors.
BACKGROUND
Our purpose was to evaluate the effectiveness of a newly developed non-invasive traction technique known as thin endoscope-assisted endoscopic submucosal dissection (TEA-ESD) procedure for the removal of colorectal laterally spreading tumors (LST).


METHODS
A total of 37 LST located in the rectum and distal sigmoid colons of 37 patients were eligible for outcome analysis. Twenty-one LST were treated with TEA-ESD and were then retrospectively compared to 16 LST that had previously been treated with standard ESD. Tumor size, en bloc resection rate, procedure time, combined number of different electrical surgical knives used during each procedure and associated complications were evaluated in this case-control study.


RESULTS
There was no statistically significant difference in tumor size between the TEA-ESD group and the ESD control group (43.6+/-16 mm and 42.4+/-14 mm, respectively). All LST were successfully resected en bloc in both groups. Procedure duration was shorter for the TEA-ESD group than the ESD control group, although the difference was not statistically significant (96+/-53 minutes vs 116+/-74 minutes; P=0.18). The percentage of cases in which only one electrical surgical knife was used during the entire procedure was significantly higher in the TEA-ESD group compared to the ESD control group (85.7% vs 31.3%; P=0.0005). There were no perforations in the TEA-ESD group while the ESD control group experienced one perforation. At the present time, TEA-ESD is limited to the rectum and distal sigmoid colon.


CONCLUSIONS
It was technically easier, safer and more cost-effective to perform ESD for LST in the rectum and the distal sigmoid colon using the newly developed TEA-ESD traction technique.
Uraoka
Toshio
T
Department of Endoscopy, Okayama University Hospital, and Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. turaoka@md.okayama-u.ac.jp
Ishikawa
Shin
S
Kato
Jun
J
Higashi
Reiji
R
Suzuki
Hideyuki
H
Kaji
Eisuke
E
Kuriyama
Motoaki
M
Saito
Shunsuke
S
Akita
Mitsuhiro
M
Hori
Keisuke
K
Harada
Keita
K
Ishiyama
Shuhei
S
Shiode
Junji
J
Kawahara
Yoshiro
Y
Yamamoto
Kazuhide
K
D000368:Aged; D020685:Colonoscopes; D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome