Clinical usefulness of a single-use splinting tube for poor endoscope operability in deep colonic endoscopic submucosal dissection

Abstract

Background and study aims: Poor endoscope operability remains a significant challenge during colorectal endoscopic submucosal dissection (ESD). We retrospectively evaluated the experience and clinical usefulness of a new single-use splinting tube in deep colonic ESD in the setting of poor scope operability. Patients and methods: Among 691 patients with colorectal tumors treated with ESD at Hiroshima University Hospital between November 2009 and July 2015, we analyzed 20 consecutive patients who underwent deep colonic ESD using a single-use splinting tube because of poor scope operability. Poor operability was defined as paradoxical movement of the endoscope, poor control with adhesions, and lesion motion with heartbeat or breathing. Technical and clinical success rates and adverse events were assessed. Results: Paradoxical movement and poor control with adhesions were improved in all cases using the single-use splinting tube. The en bloc resection rate was 95 % (19/20) and histological en bloc resection rate was 100 % (20/20). There were no complications related to use of the splinting tube. Conclusions: Use of a single-use splinting tube helped to overcome poor scope operability in deep colonic ESD.

Efficacy and suitable indication of colorectal endoscopic submucosal dissection using a balloon‐assisted endoscope

“…20 Ohya et al 11 first reported the efficacy of BAE for ESD cases with poor endoscopic operability using a single-balloon system (ST-SB 1; Fujifilm) for the small intestine. Subsequently, Asayama et al 10 reported that BAE using ST-CB 1 improved difficulties due to paradoxical movement and poor control with adhesion in 20 consecutive deep colon ESDs, allowing high rates of en block and histological resections. Furthermore, Ohata et al 9 reported that ESD cases with severe adhesions could be resected using ST-CB 1.…”

“…As a countermeasure, body position and endoscope can be changed appropriately. In addition, there are several recent reports [8][9][10][11] on the usefulness of colorectal ESD with modified balloon-assisted endoscopy (BAE). 12 In the present study, we examined the efficacy of colorectal ESD using a balloon-assisted endoscope compared to that with a conventional scope in cases judged as having poor operability on preoperative colonoscopy.…”

Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection

“…Recently, a large-diameter balloon overtube (ST-CB1, 16.2 mm outer diameter, 13.8 mm inner diameter, and 770 mm total length; Olympus) was developed. This new splinting tube can improve poor scope maneuverability during ESD in the proximal colon (Asayama et al [ 27 ]) and may enable the wide-spread use of balloon-assisted colorectal ESD even in general hospitals.…”

Standardization of endoscopic resection for colorectal tumors larger than 10 mm in diameter

“…Poor endoscope operability during ESD was reported to be an independent significant predictor of incomplete resections and perforation . Single‐balloon overtubes enable endoscopists to carry out colorectal ESD successfully in difficult cases with poor endoscope operability …”