Clin Endosc.  2017 Nov;50(6):562-568. 10.5946/ce.2017.108.

Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection

• Mizutani H
• Ono S
• Ohki D
• Takeuchi C
• Yakabi S
• Kataoka Y
• Saito I
• Sakaguchi
• Minatsuki
• Tsuji Y
• Niimi K
• Kodashima
• Yamamichi
• Fujishiro
• Koike K

• KMID: 2398307
• DOI: http://doi.org/10.5946/ce.2017.108

Abstract

Colorectal endoscopic submucosal dissection (ESD) is now a well-established endoscopic treatment for early-stage colorectal neoplasms, especially in Asian countries, including Japan. Despite the spread of colorectal ESD, there are still situations in which achieving successful submucosal dissection is difficult. Various novel techniques and devices have been developed to overcome these difficulties, and past reports have shown that some of these strategies can be applied to colorectal ESD. We review several recent developments in the field. The techniques reviewed include the pocket creation method and traction methods and the devices reviewed include the overtube with balloon and electrosurgical knives with water-jet function. These improved techniques and devices can facilitate safer, more reliable ESDs and expand its applicability and acceptability all over the world.

Keyword

Colorectal endoscopic submucosal dissection; Pocket creation method; Traction method; Overtube with balloon; Electrosurgical knives with water-jet function

MeSH Terms

Asian Continental Ancestry Group
Colorectal Neoplasms
Humans
Japan
Methods
Traction

Figure

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  Fig. 1. Pocket creation method. (A) A colon tumor, such as a laterally spreading tumor. (B) A minimal mucosal incision is performed after submucosal injection. (C, D) The endoscope is inserted into the submucosal layer from the initial incision and submucosal dissection is performed in such a way as to make a pocket under the lesion. (E, F) Finally, incisions are made around the lesion to complete en bloc resection of the remaining mucosa.

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  Fig. 2. Traction methods. (A) External forceps method. (B) Clip-with-line method. (C) Clip-and-snare method with a pre-looping technique. (D) Clip-with-loops method.

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  Fig. 3. Endoscopic images of colonic endoscopic submucosal dissection using clip-with-loops method. (A) An early adenocarcinoma 25 mm in diameter in the transverse colon. (B) After the circumferential incision was performed, poor endoscopic maneuverability prevented the fine visualization of submucosal layer. (C) One side of the loop was anchored to the edge of the lesion using a clip. (D) Another clip was attached to the opposite side of the colon wall while grasping the loop. (E) Good traction was produced, enabling a better submucosal view and safer dissection. (F) En bloc resection was performed.

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  Fig. 4. Overtube with balloon. A picture of the ST-SB1 (Olympus, Tokyo, Japan) is shown. The inflated balloon improves scope stability and maneuverability during procedures.

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  Fig. 5. Electrosurgical knives for endoscopic submucosal dissection.

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  Fig. 6. Submucosal injection using water-jet function of the Splash M knife. (A) After mucosal incision, the submucosal layer was found to be too thin for a safe dissection. The tip of the Splash M knife (shown in the bottom of the image) was put on the submucosal layer for water-jet injection. (B) After injection, the thickened submucosal layer was effectively visualized.

Reference

1. Hosokawa K, Yoshida S. [Recent advances in endoscopic mucosal resection for early gastric cancer]. Gan To Kagaku Ryoho. 1998; 25:476–483.

2. Ono H, Kondo H, Gotoda T, et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001; 48:225–229.

3. Nakajima T, Saito Y, Tanaka S, et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc. 2013; 27:3262–3270.

4. Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010; 72:1217–1225.

5. Hayashi Y, Sunada K, Takahashi H, et al. Pocket-creation method of endoscopic submucosal dissection to achieve en bloc resection of giant colorectal subpedunculated neoplastic lesions. Endoscopy. 2014; 46 Suppl 1 UCTN:E421–E422.

6. Hayashi Y, Miura Y, Yamamoto H. Pocket-creation method for the safe, reliable, and efficient endoscopic submucosal dissection of colorectal lateral spreading tumors. Dig Endosc. 2015; 27:534–535.

7. Sakamoto H, Hayashi Y, Miura Y, et al. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open. 2017; 5:E123–E129.

8. Imaeda H, Iwao Y, Ogata H, et al. A new technique for endoscopic submucosal dissection for early gastric cancer using an external grasping forceps. Endoscopy. 2006; 38:1007–1010.

9. 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.

10. 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.

11. Oyama T. Counter traction makes endoscopic submucosal dissection easier. Clin Endosc. 2012; 45:375–378.

12. Oyama T. Endoscopic submucosal dissection using a hook knife. Tech Gastrointest Endosc. 2011; 13:70–73.

13. Yamasaki Y, Takeuchi Y, Hanaoka N, et al. A novel traction method using an endoclip attached to a nylon string during colonic endoscopic submucosal dissection. Endoscopy. 2015; 47 Suppl 1 UCTN:E238–E239.

14. Yamasaki Y, Takeuchi Y, Uedo N, et al. Traction-assisted colonic endoscopic submucosal dissection using clip and line: a feasibility study. Endosc Int Open. 2016; 4:E51–E55.

15. Yoshida N, Doyama H, Ota R, Tsuji K. The clip-and-snare method with a pre-looping technique during gastric endoscopic submucosal dissection. Endoscopy. 2014; 46 Suppl 1 UCTN:E611–E612.

16. Ota R, Doyama H, Tsuji K, Yamada S. Deep colonic endoscopic submucosal dissection using a modified clip and snare method incorporating a pre-looping technique. BMJ Case Rep. 2015; 2015.

17. Yamada S, Doyama H, Ota R, et al. Impact of the clip and snare method using the prelooping technique for colorectal endoscopic submucosal dissection. Endoscopy. 2016; 48:281–285.

18. 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.

19. 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.

20. Ritsuno H, Sakamoto N, Osada T, et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg Endosc. 2014; 28:3143–3149.

21. Osada T, Sakamoto N, Shibuya T, et al. “Loops-attached rubber band” facilitation of endoscopic submucosal dissection of superficial colorectal neoplasm. Endoscopy. 2008; 40 Suppl 2:E101–E102.

22. Tomiki Y, Ishiyama S, Sugimoto K, et al. Colorectal endoscopic submucosal dissection by using latex-band traction. Endoscopy. 2011; 43 Suppl 2 UCTN:E250–E251.

23. Mori H, Kobara H, Nishiyama N, Fujihara S, Matsunaga T, Masaki T. Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection. Surg Endosc. 2017; 31:3040–3047.

24. Ohya T, Ohata K, Sumiyama K, et al. Balloon overtube-guided colorectal endoscopic submucosal dissection. World J Gastroenterol. 2009; 15:6086–6090.

25. Okamoto K, Muguruma N, Kitamura S, et al. A new large-diameter overtube for endoscopic submucosal dissection in the colon. Endoscopy. 2012; 44 Suppl 2 UCTN:E395–E396.

26. Okamoto K, Muguruma N, Kitamura S, Kimura T, Takayama T. Endoscopic submucosal dissection for large colorectal tumors using a cross-counter technique and a novel large-diameter balloon overtube. Dig Endosc. 2012; 24 Suppl 1:96–99.

27. Asayama N, Oka S, Tanaka S, et al. Clinical usefulness of a single-use splinting tube for poor endoscope operability in deep colonic endoscopic submucosal dissection. Endosc Int Open. 2016; 4:E614–E617.

28. Takeuchi Y, Uedo N, Ishihara R, et al. Efficacy of an endo-knife with a water-jet function (Flushknife) for endoscopic submucosal dissection of superficial colorectal neoplasms. Am J Gastroenterol. 2010; 105:314–322.

29. Sakaguchi Y, Tsuji Y, Fujishiro M, et al. Evaluation of endoscopic submucosal dissection using a new endosurgical knife DN-D2718B: a first clinical feasibility study. Endosc Int Open. 2017; 5:E670–E674.