BACKGROUND: Although endoscopic submucosal dissection provides higher en-bloc resection rates for larger colorectal lesions, it has not been widely adopted because of technical difficulties. Here we present our initial experience with a novel device facilitating endoluminal surgery. IMPACT OF INNOVATION:The impact of innovation is the development of an endoluminal device increasing the utilization of the endoscopic submucosal dissection technique with higher success rates and lower complications. TECHNOLOGY MATERIALS AND METHODS:This was a single-center experimental feasibility study involving 15 patients who had undergone endoscopic submucosal dissection between August 2019 and December 2020. The DiLumen C2 device was used selectively in patients with complex colorectal lesions.PRELIMINARY RESULTS: Fifteen patients with complex colorectal lesions underwent endoscopic submucosal dissection with a mean age of 64.5 years. The mean lesion size was 40.7 mm. All patients except 1 had an R0 en-bloc endoscopic submucosal dissection resection. There were no procedural or postprocedural complications. The median length of stay was 1 day. CONCLUSION: We report the safety and feasibility of the novel endoscopic platform facilitating en-bloc resection of colorectal lesions. FUTURE DIRECTIONS:The study needs validation in larger comparative series of patients with longer follow-up.

Background: We aimed to compare the outcomes and the cost differences of endoscopic submucosal dissection (ESD) procedures in the endoscopy suite (ES) versus the operating room (OR). Materials and Methods:The procedures in the OR were compared with procedures performed in the ES for demographics, lesion characteristics, procedure outcome, and procedure charges. The study included 163 procedures in the ES and 73 in the OR.Results: Both were similar in age, sex, body mass index, and intraprocedural and postoperative 30-day (late) complications. ES cases had significantly greater polyp size, were more commonly right-sided polyps, and had shorter hospital stays, with similar en bloc and margin-negative resection rates. The overall cost ratio of ESD procedures in ES to OR was 0.47 (P < 0.001). Conclusions:Colorectal ESD procedures performed in the ES have similar efficacy and safety as those in the OR. Procedures performed in the ES were associated with a shorter length of stay and significant periprocedural cost savings.