Clin Endosc.  2013 Sep;46(5):467-471.

Debates on Colorectal Endoscopic Submucosal Dissection - Traction for Effective Dissection: Gravity Is Enough

Affiliations
  • 1Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Incheon, Korea. gidoc4u@gmail.com

Abstract

Colorectal endoscopic submucosal dissection (ESD) still remains a technically difficult procedure. The maintenance of tissue tension and good submucosal exposure during dissection is one of the most important factors for an effective and safe dissection. Although various traction methods have been developed, traction by gravity is one of the most useful method for colorectal ESD. Traction using adjunctive devices can thus be reserved for extremely difficult cases or for endoscopists in their learning periods for colorectal ESD.

Keyword

Colorectal neoplasms; Endoscopic submucosal dissection; Traction; Gravitation

MeSH Terms

Colorectal Neoplasms
Gravitation
Learning
Traction

Figure

  • Fig. 1 Association between tissue tension and contact area. (A) Before applying tension. (B) After applying tension. Decreased contact area from increased tissue tension makes for an effective dissection.

  • Fig. 2 Improved submucosal exposure by traction. (A) Before traction. (B) After traction.

  • Fig. 3 Role of the distal transparent hood. (A) Insufficient submucosal exposure can be improved (B) by gently pushing the hood into the submucosal layer.

  • Fig. 4 The traction force by gravity during dissection. (A) Early stage of dissection. (B) After the dissection has progressed.


Reference

1. Taku K, Sano Y, Fu KI, et al. Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol. 2007; 22:1409–1414. PMID: 17593224.
Article
2. Kim YJ, Kim ES, Cho KB, et al. Comparison of clinical outcomes among different endoscopic resection methods for treating colorectal neoplasia. Dig Dis Sci. 2013; 58:1727–1736. PMID: 23385636.
Article
3. Oyama T. Counter traction makes endoscopic submucosal dissection easier. Clin Endosc. 2012; 45:375–378. PMID: 23251884.
Article
4. Fujishiro M, Yahagi N, Nakamura M, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc. 2006; 63:243–249. PMID: 16427929.
Article
5. Saito Y, Emura F, Matsuda T, et al. A new sinker-assisted endoscopic submucosal dissection for colorectal cancer. Gastrointest Endosc. 2005; 62:297–301. PMID: 16046999.
Article
6. Okamoto K, Muguruma N, Kitamura S, Kimura T, Takayama T. Endoscopic submucosal dissection for large colorectal tumors using a crosscounter technique and a novel large-diameter balloon overtube. Dig Endosc. 2012; 24(Suppl 1):96–99. PMID: 22533761.
Article
7. Oyama T, Y K, Shimaya S, et al. Endoscopic submucosal resection using a hook knife (hooking EMR). Stomach Intest. 2002; 37:1155–1161.
8. Chen PJ, Chu HC, Chang WK, Hsieh TY, Chao YC. Endoscopic submucosal dissection with internal traction for early gastric cancer (with video). Gastrointest Endosc. 2008; 67:128–132. PMID: 18054010.
Article
9. Ota M, Nakamura T, Hayashi K, et al. Usefulness of clip traction in the early phase of esophageal endoscopic submucosal dissection. Dig Endosc. 2012; 24:315–318. PMID: 22925282.
Article
10. Jeon WJ, You IY, Chae HB, Park SM, Youn SJ. A new technique for gastric endoscopic submucosal dissection: peroral traction-assisted endoscopic submucosal dissection. Gastrointest Endosc. 2009; 69:29–33. PMID: 19111686.
Article
11. Li CH, Chen PJ, Chu HC, et al. Endoscopic submucosal dissection with the pulley method for early-stage gastric cancer (with video). Gastrointest Endosc. 2011; 73:163–167. PMID: 21030018.
Article
12. Okamoto K, Okamura S, Muguruma N, et al. Endoscopic submucosal dissection for early gastric cancer using a cross-counter technique. Surg Endosc. 2012; 26:3676–3681. PMID: 22692462.
Article
13. Lee BI, Kim BW, Choi H, et al. Traction with using a rubber band and clips for effective endoscopic submucosal dissection. Korean J Gastrointest Endosc. 2008; 36:341–348.
14. Parra-Blanco A, Nicolas D, Arnau MR, Gimeno-Garcia AZ, Rodrigo L, Quintero E. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest Endosc. 2011; 74:1137–1141. PMID: 22032320.
Article
15. Matsumoto K, Nagahara A, Ueyama H, et al. Development and clinical usability of a new traction device "medical ring" for endoscopic submucosal dissection of early gastric cancer. Surg Endosc. Epub 2013 Mar 23. DOI: http://dx.doi.org/10.1007/s00464-013-2887-6.
Article
16. Sakamoto N, Osada T, Shibuya T, et al. Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction (with video). Gastrointest Endosc. 2009; 69:1370–1374. PMID: 19403131.
Article
17. Sakamoto N, Osada T, Shibuya T, et al. The facilitation of a new traction device (S-O clip) assisting endoscopic submucosal dissection for superficial colorectal neoplasms. Endoscopy. 2008; 40(Suppl 2):E94–E95. PMID: 19085712.
Article
18. Gotoda T, Oda I, Tamakawa K, Ueda H, Kobayashi T, Kakizoe T. Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest Endosc. 2009; 69:10–15. PMID: 18599053.
Article
19. Imaeda H, Hosoe N, Ida Y, et al. Novel technique of endoscopic submucosal dissection by using external forceps for early rectal cancer (with videos). Gastrointest Endosc. 2012; 75:1253–1257. PMID: 22624814.
Article
20. Motohashi O. Two-point fixed endoscopic submucosal dissection in rectal tumor (with video). Gastrointest Endosc. 2011; 74:1132–1136. PMID: 21944316.
Article
21. Motohashi O, Nishimura K, Nakayama N, Takagi S, Yanagida N. Endoscopic submucosal dissection (two-point fixed ESD) for early esophageal cancer. Dig Endosc. 2009; 21:176–179. PMID: 19691765.
Article
22. Imaeda H, Hosoe N, Ida Y, et al. Novel technique of endoscopic submucosal dissection using an external grasping forceps for superficial gastric neoplasia. Dig Endosc. 2009; 21:122–127. PMID: 19691787.
Article
23. Teoh AY, Chiu PW, Hon SF, Mak TW, Ng EK, Lau JY. Ex vivo comparative study using the Endolifter® as a traction device for enhancing submucosal visualization during endoscopic submucosal dissection. Surg Endosc. 2013; 27:1422–1427. PMID: 23093235.
Article
24. Uraoka T, Ishikawa S, Kato J, et al. Advantages of using thin endoscopeassisted endoscopic submucosal dissection technique for large colorectal tumors. Dig Endosc. 2010; 22:186–191. PMID: 20642607.
Article
25. Uraoka T, Kato J, Ishikawa S, et al. Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos). Gastrointest Endosc. 2007; 66:836–839. PMID: 17905031.
Article
26. Higuchi K, Tanabe S, Azuma M, et al. Double-endoscope endoscopic submucosal dissection for the treatment of early gastric cancer accompanied by an ulcer scar (with video). Gastrointest Endosc. 2013; 78:266–273. PMID: 23472995.
Article
27. Ahn JY, Choi KD, Lee JH, et al. Is transnasal endoscope-assisted endoscopic submucosal dissection for gastric neoplasm useful in training beginners? A prospective randomized trial. Surg Endosc. 2013; 27:1158–1165. PMID: 23093232.
Article
28. Ahn JY, Choi KD, Choi JY, et al. Transnasal endoscope-assisted endoscopic submucosal dissection for gastric adenoma and early gastric cancer in the pyloric area: a case series. Endoscopy. 2011; 43:233–235. PMID: 21165828.
Article
29. Kondo H, Gotoda T, Ono H, et al. Percutaneous traction-assisted EMR by using an insulation-tipped electrosurgical knife for early stage gastric cancer. Gastrointest Endosc. 2004; 59:284–288. PMID: 14745409.
Article
30. von Delius S, Karagianni A, von Weyhern CH, et al. Percutaneously assisted endoscopic surgery using a new PEG-minitrocar for advanced endoscopic submucosal dissection (with videos). Gastrointest Endosc. 2008; 68:365–369. PMID: 18561928.
Article
31. Hijikata Y, Ogasawara N, Sasaki M, et al. Endoscopic submucosal dissection with sheath-assisted counter traction for early gastric cancers. Dig Endosc. 2010; 22:124–128. PMID: 20447206.
Article
32. Yonezawa J, Kaise M, Sumiyama K, Goda K, Arakawa H, Tajiri H. A novel double-channel therapeutic endoscope ("R-scope") facilitates endoscopic submucosal dissection of superficial gastric neoplasms. Endoscopy. 2006; 38:1011–1015. PMID: 17058166.
Article
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