Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD

Goda, Yasuhiro; Mori, Hideki; Kobara, Hideki; Masaki, Tsutomu

doi:10.1080/13645706.2018.1455706

Cited by 9 publications

(6 citation statements)

References 16 publications

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“…In this method, a submucosal pocket is created at the beginning without extending the mucosal incision; as a result, stable conditions and good submucosal visualization can be obtained 31 . And a traction-assisted ESD technique has been reported 32 33 . Using these modified endoscopic treatments, outcomes of duodenal ESD have improved.…”

Section: Discussionmentioning

confidence: 99%

Predictors of technical difficulty with duodenal ESD

et al. 2019

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Background and study aims Duodenal endoscopic submucosal dissection (ESD) is still considered technically challenging; however, few studies have objectively analyzed predictors of the technical difficulty. Therefore, the aim of the current study was to elucidate predictors of the technical difficulty of duodenal ESD. Patients and methods This was a retrospective observational study. From June 2010 to June 2017, a total of 174 consecutive patients with superficial duodenal epithelial neoplasia who underwent ESD were included in this study. We tried to identify predictors for technical difficulty of ESD by defining technical difficulty as either procedure time > 100 minutes or intraprocedural perforation. Moreover, we constructed a scoring system consisting of factors that were significant in the multivariate analysis. Results The proportion of patients with technical difficulty was 34.5 %. In the multivariate analysis, lesion location in flexural part [odds ratio (OR), 2.61; 95 % confidence interval (CI), 1.02 – 6.68], larger lesion size (> 40 mm) (OR, 5.26; 95% CI, 2.15 – 12.9), and occupied circumference > 50 % of the duodenum (OR, 5.80; 95 % CI, 1.83 – 18.4) were associated with technical difficulty. Conclusion A lesion location in flexural part, lesion size >40 mm and occupied circumference > 50 % were risk factors for technical difficulty of duodenal ESD.

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Section: Discussionmentioning

confidence: 99%

Predictors of technical difficulty with duodenal ESD

et al. 2019

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“…An RCT showed a significant reduction in procedural time but only for lesions located in the greater curvature of the upper or middle stomach [79]. In the duodenum, traction has also been reported in a case series of 29 patients, with a shorter procedural duration and reduced risk of perforation [80].…”

Section: Evidencementioning

confidence: 95%

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Libânio

Pimentel‐Nunes

Bastiaansen³

et al. 2023

Endoscopy

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ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.

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“…In the present case, we showed the case of successful traction‐assisted ESD using dental floss and a clip for a huge SNADET in which severe fibrosis of the submucosal layer was expected due to repeated biopsies. Traction‐assisted ESD methods include thread and clip traction, S‐O clip, ring‐shaped thread traction, clip‐flap method, and clip‐and‐snare method . For ESD of lesions in the esophagus, stomach, and colorectum, the most appropriate method is selected by considering several factors, such as the space within the hollow organ where the lesion is located and the need for removing the scope while applying traction.…”

Section: Discussionmentioning

confidence: 99%

“…For ESD of lesions in the esophagus, stomach, and colorectum, the most appropriate method is selected by considering several factors, such as the space within the hollow organ where the lesion is located and the need for removing the scope while applying traction. Regarding duodenal ESD, traction application using an S‐O clip and ring‐shaped thread has been reported. However, the traction force cannot be controlled in these traction methods, and these devices are anchored to the duodenal mucosa on the opposite wall.…”

Section: Discussionmentioning

confidence: 99%

Successful traction‐assisted endoscopic submucosal dissection using dental floss and a clip for a huge superficial nonampullary duodenal epithelial tumor with severe fibrosis (with video)

et al. 2018

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Recently, traction‐assisted endoscopic submucosal dissection (ESD) using a clip and thread was reported as useful for treating lesions in the esophagus, stomach, and colorectum in terms of shortening the duration of the procedures and reducing the risk of intraoperative perforation. However, no traction method using the thread and clip for duodenal ESD as described in this article has been reported to date. We report a case in which traction‐assisted ESD using dental floss and a clip was successfully performed on a huge superficial nonampullary duodenal epithelial tumor accompanied by severe fibrosis caused by preoperative biopsies. A 65‐year‐old woman had a 55‐mm flat‐elevated tumor in the second part of the duodenum. Severe fibrosis of the submucosal layer was expected due to repeated biopsies at the same site by the patient’s previous endoscopist. We selected ESD for this lesion, and the initial incision was started from the side proximal to the lesion, but it was difficult to insert the scope under the submucosal layer directly beneath the biopsy scar. Therefore, traction with an endoclip and dental floss was performed to lift the lesion. Excellent traction allowed safe resection of the fibrotic part under accurate visual observation. Finally, the lesion was resected en bloc without adverse events. Traction‐assisted ESD using dental floss and a clip is likely to be an effective adjunctive technique for quick, safe, and successful resection of lesions in the duodenum on which it is difficult to perform ordinary ESD and that have a high probability of intraoperative perforation and massive bleeding.

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Efficacy of sufficient operation view by ring-shaped thread counter traction for safer duodenal ESD

Abstract: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.

Cited by 9 publications

References 16 publications

Predictors of technical difficulty with duodenal ESD

Predictors of technical difficulty with duodenal ESD

Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review

Successful traction‐assisted endoscopic submucosal dissection using dental floss and a clip for a huge superficial nonampullary duodenal epithelial tumor with severe fibrosis (with video)

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