Clin Endosc.  2020 Mar;53(2):206-212. 10.5946/ce.2019.117.

Efficacy and Safety of Complete Endoscopic Resection of Colorectal Neoplasia Using a Stepwise Endoscopic Protocol with SOUTEN, a Novel Multifunctional Snare

• Yoshii S
• Kubo M
• Matsumoto
• Kikuchi T
• Takakuwa Y

• KMID: 2500888
• DOI: http://doi.org/10.5946/ce.2019.117

Abstract

Background/Aims
A multifunctional snare SOUTEN has a sharp tip at the top of the snare loop that enables incision of the mucosa, dissection of the submucosal layer, and snaring of lesion. This study assessed the efficacy and safety of complete endoscopic resection of colorectal neoplasia using SOUTEN.
Methods
We analyzed the rates of gross en bloc resection and complete resections of 108 consecutive tumors from 69 patients resected by precutting endoscopic mucosal resection (precutting), hybrid endoscopic submucosal dissection (hybrid), or conventional endoscopic submucosal dissection (conventional) using SOUTEN.
Results
Out of the 108 tumors, 50 were resected by precutting, 27 were resected by hybrid after attempting precutting, and the remaining 31 were resected by conventional after attempting precutting and hybrid resections. The median tumor sizes were 14.5 mm for precutting, 16.4 mm for hybrid, and 21.1 mm for conventional. The success rate of gross en bloc resection and histological complete resection were 100% and 94.0% for precutting, 96.4% and 96.4% for hybrid, and 100% and 100% for conventional method, respectively. No procedure-related complication occurred.
Conclusions
By using SOUTEN, precutting and hybrid were successfully performed on 10–30 mm tumors with a shorter procedure time than conventional without major complications.

Keyword

Hybrid endoscopic submucosal dissection; Multifunctional snare; Precutting endoscopic mucosal resection; SOUTEN

Figure

• 

  Fig. 1. Image of SOUTEN (Kaneka Medix, Tokyo, Japan) snare. (A) The multifunctional snare was designed to achieve precutting endoscopic mucosal resection and hybrid endoscopic submucosal dissection. (B) A 1.5-mm needle-knife with a knob-shaped tip was attached to the top of the loop. (C) The length of the loop was 40 mm.

• 

  Fig. 2. (A) A 30-mm granular type laterally spreading tumor was located in the lower rectum. (B) Local injection of sodium hyaluronate solution. (C) Mucosal incision was performed using a needle-knife of the top of the snare. (D) Adequate trimming was performed. (E) The snare was placed on the dissection plane. (F) The tumor was tightly snared. (G) Post-precutting endoscopic mucosal resection. The lesion was completely resected. (H) The resected specimen. En bloc resection was achieved.

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