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

Abstract

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.

Usefulness of S‐O clip in endoscopic submucosal dissection of a colorectal tumor which progressed to the ileum

“…Endoscopic submucosal dissection (ESD) enables en‐bloc resections of laterally spreading colorectal tumors regardless of size. The S‐O clip (Zeon Medical, Tokyo, Japan) is a traction device that assists in recognizing the submucosa visually by aiding lesion exposure following peripheral mucosal incisions 1–4 . Here, we report a case where an S‐O clip was used during ESD of a colorectal tumor.…”

Salvage endoscopic submucosal dissection for local residual/recurrent colorectal tumor after endoscopic resection: Large multicenter 10‐year study

“…In local residual/recurrent colorectal tumors, complete resection by endoscopic mucosal resection (EMR) as a salvage treatment is sometimes technically difficult, because sufficient mucosal lifting by submucosal injection may not be obtained (positive non‐lifting sign) due to severe submucosal fibrosis. By contrast, endoscopic submucosal dissection (ESD) is capable of achieving en bloc resection, even for tumors with severe submucosal fibrosis 1–8 . Thus, this procedure is becoming a popular and reliable treatment option for colorectal tumors due to improvements in endoscopes, related devices, and endoscopic techniques.…”

Use of a new traction device to expose the base of a pedunculated appendiceal polyp

“…1,2 The S-O clip is widely used for endoscopic submucosal dissection in the colon, stomach, and duodenum because of its safety and usefulness. [3][4][5][6] In addition to using the S-O clip technique, reports have been made regarding the usefulness of the traction strategy using clips and rubber bands for endoscopic submucosal dissection. 7,8 A 67-year-old man underwent a positron emission tomography/CT scan for thyroid cancer and was found to have an accumulation in the cecum (SUVmax value: 8.1) and the thyroid gland.…”

“… 1 , 2 The S-O clip is widely used for endoscopic submucosal dissection in the colon, stomach, and duodenum because of its safety and usefulness. 3 , 4 , 5 , 6 In addition to using the S-O clip technique, reports have been made regarding the usefulness of the traction strategy using clips and rubber bands for endoscopic submucosal dissection. 7 , 8…”