Endoscopic submucosal dissection for large superficial colorectal tumors using the “clip-flap method”

Yamamoto, Katsumi; Hayashi, Shiro; Saiki, Hirotsugu; Indo, Naohiko; Nakabori, Tasuku; Yamamoto, Masashi; Shibuya, Mitsuhiko; Nishida, Tsutomu; Ichiba, Makoto; Inada, Masami

doi:10.1055/s-0034-1390739

Cited by 28 publications

(30 citation statements)

References 12 publications

(17 reference statements)

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“…Clip flap is simple and effective, but it is an indirect traction method which strengthens the traction force by gravity. Thus, it does not always provide sufficient traction . To overcome these problems, we modified the “clip‐with‐line” method and developed TAC‐ESD, which does not require withdrawal of the colonoscope.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of traction‐assisted colorectal endoscopic submucosal dissection using a clip‐and‐thread technique: A prospective randomized study

Yamasaki

Takeuchi

Uedo

et al. 2018

Digestive Endoscopy

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Section: Discussionmentioning

confidence: 99%

“…Thus, it does not always provide sufficient traction. 26 To overcome these problems, we modified the "clip-with-line" method [27][28][29][30][31] and developed TAC-ESD, which does not require withdrawal of the colonoscope. However, TAC-ESD has a weak point.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of traction‐assisted colorectal endoscopic submucosal dissection using a clip‐and‐thread technique: A prospective randomized study

Yamasaki

Takeuchi

Uedo

et al. 2018

Digestive Endoscopy

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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%

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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“…We have previously reported that risk factors for incomplete resection or perforation in colorectal ESD are poor operability of the scope, submucosal deep invasion, or severe fibrosis [10,11]. Several traction methods can be used to maintain the field of view [12][13][14][15][16][17][18][19][20][21][22]. However, with conventional traction methods, it is difficult to control the direction and intensity of traction or a combination of special equipment may be required.…”

Section: Introductionmentioning

confidence: 99%

Clinical usefulness of the S-O clip during colorectal endoscopic submucosal dissection in difficult-to-access submucosal layer

et al. 2020

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Background and study aims In colorectal endoscopic submucosal dissection (ESD), the S-O clip improves the accessibility to the submucosal layer of the colon. However, its safety and usefulness in difficult colorectal ESDs are unclear. Thus, in this study, we aimed to assess the effectiveness of the S-O clip in colorectal ESD in the difficult-to-access submucosal layer. Patients and methods From January 2016 to December 2016, 189 consecutive cases of colorectal ESD were performed at Hiroshima University Hospital before the S-O clip was introduced. Between January 2017 and June 2018, among 271 consecutive colorectal ESD cases, 41 cases were performed colorectal ESD using the S-O clip. We compared outcomes between the two groups (41 cases with S-O clip [use group] and 189 cases without S-O clip [non-use group]) using propensity score matching. Results Prior to propensity score matching, 41 cases with the S-O clip (use group) and 189 cases without the S-O clip (non-use group) were extracted. The degree of submucosal fibrosis was more severe and the procedure time was longer in the use group than in the non-use group. In the use and non-use groups, en bloc resection (100 % vs. 94.7 %) and complete en bloc resection (100 % vs. 92.6 %) rates were satisfactory. After propensity score matching, 33 cases in each group were extracted. As a result, complete en bloc resection rate was significantly higher in the use group than in the non-use group (100 % vs. 84.9 %). Conclusion The S-O clip is effective and can be used safely in colorectal ESD in the difficult-to-access submucosal layer.

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Endoscopic submucosal dissection for large superficial colorectal tumors using the “clip-flap method”

Abstract: The clip-flap method is a simple, safe, and effective option for ESD of large superficial colorectal tumors.

Cited by 28 publications

References 12 publications

Efficacy of traction‐assisted colorectal endoscopic submucosal dissection using a clip‐and‐thread technique: A prospective randomized study

Efficacy of traction‐assisted colorectal endoscopic submucosal dissection using a clip‐and‐thread technique: A prospective randomized study

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)

Clinical usefulness of the S-O clip during colorectal endoscopic submucosal dissection in difficult-to-access submucosal layer

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