Endoscopic submucosal dissection (ESD) is a promising endoscopic procedure that is increasingly being used for endoscopic resection of large colorectal lesions that may be difficult to remove en-bloc by snare polypectomy. The greatest challenge for ESD remains technical difficulty in achieving optimal traction. In the following study, we evaluate the use of Gel-based Transanal Access Platform, typically used for Transanal Minimally Invasive Surgery (TAMIS) to facilitate ESD of colorectal lesions by facilitating use of two separate endoscopes simultaneously. Patients undergoing colorectal ESD were consented for use of this device during their procedure. If difficulty with traction occurred during the submucosal dissection portion of the procedure, the device was employed as follows: A 4x4 cm Gel based-TAMIS access device was inserted into the anal canal. Two access holes were made in the gel cover 2cm apart with the pre-supplied trocars to allow for the passage of a 1T therapeutic gastroscope and an ultraslim gastroscope. After submucosal injection and circumferential incision, the pediatric forceps were passed through the working channel of the ultraslim scope, and the edge of the lesion was grasped and then manipulated to allow for dynamic traction of the lesion. Outcomes measured included procedure time, traction assessment, interference between two scopes and adverse events including anal discomfort and post procedure incontinence. Over the study period 5 subjects have required the TAMIS device to assist with traction. All cases have been performed by a single endoscopist. The average procedure time with use of the device over 5 cases was 19mins per 1cm of lesion. Traction was felt to be excellent in all cases. There was minimal to no interference with the second scope. All cases resulted in en-bloc and R0 resections. 1 case was a T2 cancer with R0 resection. 1 case was intramucosal cancer. 3 cases were tubulovillous adenoma with high grade dysplasia. There were no complications in all 5 cases. Zero patients complained of anorectal pain after the procedure or experienced incontinence. By using a commercially available Transanal Access Platform for the first time in an endoscopic procedure, there was greater ease performing ESD. This device allowed the insertion of an additional scope which provided more traction and assisted in resecting each lesion without any reported friction between the two scopes. The set-up of this device is simple and this device appears suitable not only for laparoscopic surgical procedures but also for endoscopic interventions. This is a lower cost option for ESD traction than other proprietary traction devices on the market. Further studies are underway to determine the technical success, easy of use, and safety of this dual scope with TAMIS platform technique for colorectal ESD.Second scope with Traction assisting with Dual Knife DissectionView Large Image Figure ViewerDownload Hi-res image Download (PPT)