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01-11-2014

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

Authors: 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

Published in: Surgical Endoscopy | Issue 11/2014

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.

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

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–S30PubMedCrossRef

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

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 24:343–352PubMedCrossRef

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

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 38:987–990PubMedCrossRef

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 33:221–226PubMedCrossRef

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 38:980–986PubMedCrossRef

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 41:751–757PubMedCrossRef

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 66:100–107PubMedCrossRef

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 26:1587–1594PubMedCrossRef

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 21:122–127PubMedCrossRef

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 38:1016–1023PubMedCrossRef

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 62:297–301PubMedCrossRef

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 59:284–288PubMedCrossRef

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 22:186–191PubMedCrossRef

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 69:10–15PubMedCrossRef

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 69:1370–1374PubMedCrossRef

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–E95PubMedCrossRef

20.

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

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 69:278–283PubMedCrossRef

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 27:31–39PubMedCrossRef

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 72:1217–1225PubMedCrossRef

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):67–72PubMedCrossRef

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 45:30–36PubMedCrossRef

Title: Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S–O clip
Authors: 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
Publication date: 01-11-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3572-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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