Effectiveness of S-O Clip-Assisted Colorectal Endoscopic Submucosal Dissection.

Haruka Fujinami,Shinya Kajiura,Saeko Takahashi,Akira Teramoto,Ichiro Yasuda,Takayuki Ando

doi:10.3390/jcm11010141

Haruka Fujinami, Shinya Kajiura + Show 4 more

Open Access

https://doi.org/10.3390/jcm11010141

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Abstract

This study aimed to assess the utility of the S-O clip during colorectal endoscopic submucosal dissection (ESD). We conducted a retrospective study on 185 patients who underwent colorectal ESD from January 2015 to January 2020. The patients were divided into two groups: before and after the introduction of the S-O clip. Forty-two patients underwent conventional ESD (CO group) and 29 patients underwent ESD using the S-O clip (SO group). We compared the surgery duration, dissection speed, en bloc resection rate, and complication rate between both groups. Compared with the CO group, the SO group had a significantly shorter surgery duration (70.7 ± 37.9 min vs. 51.2 ± 18.6 min; p = 0.017), a significantly higher dissection speed (15.1 ± 9.0 min vs. 26.3 ± 13.8 min; p < 0.001), a significantly higher en bloc resection rate (80.9% vs. 98.8%; p ≤ 0.001), and a significantly lower perforation rate (4.3% vs. 1.3%). In the right colon, the surgery duration was significantly shorter and the dissection speed was significantly higher in the SO group than in the CO group. Moreover, the rate of en bloc resection improved significantly in the right colon. S-O clip-assisted ESD reduces the procedure time and improves the treatment effects, especially in the right colon.

Highlights

Academic Editor: Hidekazu SuzukiEndoscopic submucosal dissection (ESD) is an established treatment for intramucosal tumors of the gastrointestinal tract, including the colon and rectum
The dissection speed was calculated by dividing the resected area by September to January
We divided the patients into two groups according the timing of endoscopic submucosal dissection (ESD); as massive intraoperative bleeding that required transfusion or as group postoperative

Summary

Introduction

Endoscopic submucosal dissection (ESD) is an established treatment for intramucosal tumors of the gastrointestinal tract, including the colon and rectum. This method, compared to conventional endoscopic mucosal resection (EMR), enables en bloc resection of larger lesions and has a low recurrence rate of 0.4–1.0% [1,2]. Colorectal ESD has several limitations, including an anatomically difficult procedure, a longer procedure compared to that of endoscopic mucosal resection, and a high risk of perforation and bleeding [2,3,4,5]. Several traction techniques on lesions have been reported to be effective during ESD for large early gastric and colorectal cancers [8].

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