title: Efficient hemostatic method for endoscopic submucosal dissection of colorectal tumors.
abstract: OBJECTIVE
  To evaluate a new hemostatic method using hemostatic forceps to prevent perforation and perioperative hemorrhage during colonic endoscopic submucosal dissection (ESD).
  
  
  METHODS
  We studied 250 cases, in which ESD for colorectal tumors was performed at the Kyoto Prefectural University of Medicine or Nara City Hospital between 2005 and 2010. We developed a new hemostatic method using hemostatic forceps in December 2008 for the efficient treatment of submucosal thick vessels. ESD was performed on 126 cases after adoption of the new method (the adopted group) and the new method was performed on 102 of these cases. ESD was performed on 124 cases before the adoption of the new method (the unadopted group). The details of the new method are as follows: firstly, a vessel was coagulated using the hemostatic forceps in the soft coagulation mode according to the standard procedure, and the coagulated vessel was removed using the forceps in the "endocut" mode without perioperative hemorrhage. Secondly, the partial surrounding submucosa was dissected using the forceps in the endocut mode. In the current study, we evaluated the efficacy of this method.
  
  
  RESULTS
  Coagulated vessels were successfully removed using the hemostatic forceps in all 102 cases without severe perioperative hemorrhage. Moderate perioperative hemorrhage occurred in five cases (4.9%); however, it was stopped by immediately reuse of the hemostatic forceps. The partial surrounding submucosa was dissected using the forceps in all 102 cases. In the adopted group, the median operation time was 105 min. The proportion of endoscopic en bloc resection was 92.8% (P < 0.01) compared to 80.6% in the unadopted group. The postoperative hemorrhage and perforation rates were 2.3% and 2.3%. The rate of perforation was significantly lower than that in the unadopted group (9.6%, P < 0.01). We evaluated the ease of use of this method by allowing our three trainees to performed ESD on 46 cases, which were accomplished without any severe hemorrhage.
  
  
  CONCLUSIONS
  The new method effectively treated submucosal thick vessels and shows promise for the prevention of perforation and perioperative hemorrhage in colonic ESD.
authors.affiliation: Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. naohisa@koto.kpu-m.ac.jp
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yoshida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Naito
authors.forename: Munehiro
authors.initials: M
authors.lastname: Kugai
authors.forename: Ken
authors.initials: K
authors.lastname: Inoue
authors.forename: Naoki
authors.initials: N
authors.lastname: Wakabayashi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yagi
authors.forename: Akio
authors.initials: A
authors.lastname: Yanagisawa
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007564:Japan; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
references.citation: J Gastroenterol. 2006 Oct;41(10):929-42
references.pmid: 17096062
references.citation: Am J Gastroenterol. 2010 Feb;105(2):314-22
references.pmid: 19773749
references.citation: Gastrointest Endosc. 2009 Jun;69(7):1370-4
references.pmid: 19403131
references.citation: Dig Endosc. 2009 Jul;21 Suppl 1:S31-7
references.pmid: 19691730
references.citation: Surg Laparosc Endosc Percutan Tech. 2008 Dec;18(6):592-7
references.pmid: 19098667
references.citation: Clin Gastroenterol Hepatol. 2007 Jun;5(6):678-83; quiz 645
references.pmid: 17466600
references.citation: Int J Colorectal Dis. 2010 Apr;25(4):455-61
references.pmid: 19921221
references.citation: J Gastroenterol. 2004 Jun;39(6):534-43
references.pmid: 15235870
references.citation: Endoscopy. 2009 Apr;41(4):340-5
references.pmid: 19340739
references.citation: J Gastroenterol. 2008;43(9):641-51
references.pmid: 18807125
references.citation: Gastrointest Endosc. 2007 Nov;66(5):966-73
references.pmid: 17524403
references.citation: World J Gastroenterol. 2010 Apr 14;16(14):1688-95
references.pmid: 20379999
references.citation: Endoscopy. 2004 Jul;36(7):584-9
references.pmid: 15243879
references.citation: Endoscopy. 2003 Aug;35(8):690-4
references.pmid: 12929067
references.citation: Endoscopy. 2009 Sep;41(9):758-61
references.pmid: 19746316
references.citation: Gastrointest Endosc. 2007 Jul;66(1):100-7
references.pmid: 17591481