title: Advantages of using thin endoscope-assisted endoscopic submucosal dissection technique for large colorectal tumors.
abstract: 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.
authors.affiliation: 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
authors.forename: Toshio
authors.initials: T
authors.lastname: Uraoka
authors.forename: Shin
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.forename: Reiji
authors.initials: R
authors.lastname: Higashi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Suzuki
authors.forename: Eisuke
authors.initials: E
authors.lastname: Kaji
authors.forename: Motoaki
authors.initials: M
authors.lastname: Kuriyama
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Saito
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Akita
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hori
authors.forename: Keita
authors.initials: K
authors.lastname: Harada
authors.forename: Shuhei
authors.initials: S
authors.lastname: Ishiyama
authors.forename: Junji
authors.initials: J
authors.lastname: Shiode
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kawahara
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: 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