Successful Creation of the Mucosal Flap in the Colorectal Endoscopic Submucosal Dissection Using a Push-Up, Grasp, and Cutting Technique

Abstract

Endoscopic submucosal dissection (ESD) has become widely used for treatment of colorectal tumors, but creation of the initial mucosal flap of the colorectal ESD procedure is difficult for novice surgeons. The usefulness of a clutch cutter (CC) (Fujifilm, Tokyo, Japan), a scissor-type knife, for colorectal ESD has recently been reported. [1][2][3][4] We report successful creation of the initial mucosal flap in the colorectal ESD procedure using a push-up, grasp, and cutting (PGC) technique with a CC. A 0.4% sodium hyaluronate (MucoUp; Boston Scientific, Marlborough, MA) was injected into the submucosa before mucosal and submucosal cutting. CC was powered by VIO 3 electrosurgical generator (ERBE Elektromedizin, GmbH, Tübingen, Germany), which supported mucosal incision and submucosal dissection (endocut I function [effect 2, duration 3, interval 1] and forced coagulation [effect 2.4]), and hemostasis (soft coagulation, effect 6). Figure 1. Tumor before the push-up, grasp, and cutting (PGC) technique and the dissection after the PGC technique. (A) The tumor was on the fold of the transverse colon. (B) Adequate dissection directly beneath the lesion was performed with a stable visual field after the PGC technique.

Mucosal flap creation in colorectal endoscopic submucosal dissection using a V-shaped incision

“…The creation of a flap at the beginning of colorectal endoscopic submucosal dissection (ESD) of lesions on the semilunar fold or in the cecum is challenging because the knife is at right angles to the muscle layer. Thus, several innovations in flap creation have been reported 1 2 . The usefulness of traction-assisted ESD has been reported, including the clip-with-line 3 and the S-O clip 4 methods, which require a clip to be attached to the flap.…”