Efficacy of single‐balloon overtube for endoscopic submucosal dissection in the proximal colon: A propensity score‐matched analysis

Abstract

Objectives A single‐balloon overtube (SBO) can improve poor scope operability during colonic endoscopic submucosal dissection (ESD). We aimed to evaluate the clinical usefulness of SBO for ESD in the proximal colon and the predictive factors for cases in which SBO is useful. Methods A total of 88 tumors located in the proximal colon resected by balloon‐assisted ESD (BA‐ESD) using SBO and 461 tumors resected by conventional ESD (C‐ESD) between June 2015 and November 2020 were considered. Seventy‐eight tumors each in the BA‐ESD and C‐ESD groups were matched by propensity score matching. ESD outcomes were compared between the groups, and a decision tree analysis was performed to explore the predictive factors for cases in which SBO is useful. Results There were no significant differences between the groups in the major outcomes such as en bloc resection rate (95% vs. 99%, p = 0.17), R0 resection rate (92% vs. 96%, p = 0.30), mean dissection speed (16 mm 2 /min vs. 16 mm 2 /min, p = 0.53), and intraoperative perforation rate (5% vs. 6%, p = 0.73). Even when considering cases with poor preoperative scope operability, there were no significant differences between the groups. Comparison of tumors ≥40 mm in diameter between the groups confirmed that the intraoperative perforation rate was significantly lower in the BA‐ESD group than in the C‐ESD group (0% vs. 24%, p = 0.0188). Conclusion SBO is useful for ESD of tumors ≥40 mm in diameter in the proximal colon to prevent intraoperative perforation, which usually has a long procedure time.

A randomized prospective study comparing single‐balloon‐assisted colonoscopy and cap‐assisted colonoscopy in patients with previous incomplete conventional colonoscopy

“…This method was also used for colonic endoscopic submucosal dissection with poor endoscope operability to stabilize the scope position. 26,27 Double-balloon-assisted colonoscopy (DBC) is also used in rescuing patients with incomplete conventional colonoscopy before. Studies had been carried out to compare DBC and SBC in this issue.…”

“…Therefore, we can examine colonic mucosa more completely without risk of rapid slipping out of endoscope during withdrawal. This method was also used for colonic endoscopic submucosal dissection with poor endoscope operability to stabilize the scope position 26,27 …”

Device-assisted traction methods in colorectal endoscopic submucosal dissection and options for difficult cases

“…BAE may reduce the risk of intraoperative perforation. A propensity score matching analysis comparing BAE-ESD and C-ESD in the proximal colon revealed that BAE-ESD significantly decreased intraoperative perforation for lesions ≥ 40 mm in diameter (0% vs 24%, P = 0.0188), although there were no significant differences in the en bloc resection rate (95% vs 99%, P = 0.17), R0 resection rate (92% vs 96%, P = 0.30), mean dissection speed (16 mm 2 /min vs 16 mm 2 /min, P = 0.53), and intraoperative perforation (5% vs 6%, P = 0.73) between BAE-ESD and C-ESD[ 14 ]. Combining T-ESD with BAE may improve procedure-related outcomes in colorectal ESD cases with poor endoscope maneuverability.…”

A balloon‐assisted endoscopic submucosal dissection using long colonoscope and guidewire

“…The efficacy of balloon-assisted ESD (BA-ESD) as an approach for proximal colorectal tumors has been reported. 1 However, some cases fail to reach the lesion even with balloon-assisted endoscopy (BAE) because of the intestinal loops and excessive intestinal elongation. (Figure 1b), and Kudo's pit pattern classification after crystal violet staining showed types IIIL and IV pit patterns (Figure 1c,d).…”

“…Endoscopic submucosal dissection (ESD) for proximal colorectal tumors is at times difficult because of the formation of intestinal loops during long procedures, leading to paradoxical movement. The efficacy of balloon‐assisted ESD (BA‐ESD) as an approach for proximal colorectal tumors has been reported 1 . However, some cases fail to reach the lesion even with balloon‐assisted endoscopy (BAE) because of the intestinal loops and excessive intestinal elongation.…”