Dynamic and multifocal clip and band countertraction for endoscopic submucosal dissection

Mavrogenis, Georgios; Bazerbachi, Fateh; Tsevgas, Ioannis; Zachariadis, Dimitrios

doi:10.1016/j.vgie.2020.04.024

Cited by 7 publications

(9 citation statements)

References 11 publications

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“…In terms of dissection strategy, circumferential incision and then standard dissection was applied for gastric and esophageal lesions, while tunneling techniques [ 12 , 13 ] were mainly applied for duodenal and colorectal lesions. Additional techniques included the saline immersion technique [ 14 ] and countertraction, such as the clip-and-snare [ 15 ], the clip-and-line and the clip-and-band techniques [ 14 , 16 ]. However, from case #40 we systematically applied standard dynamic or multifocal clip-and-band countertraction [ 16 ] to increase the dissection speed and diminish the perforation risk.…”

Section: Methodsmentioning

confidence: 99%

The learning experience for endoscopic submucosal dissection in a non-academic western hospital: a single operator’s untutored, prevalence-based approach

Mavrogenis¹,

Ntourakis

Wang

et al. 2021

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Background Studies of learning experience in endoscopic submucosal dissection (ESD) commonly originate from the East. Little is known about the performance of ESD in low-volume western centers. Furthermore, it is unclear whether ESD can be self-taught without a tutored approach. Methods We performed a retrospective analysis of consecutive ESDs, performed in an untutored prevalence-based fashion by a single operator at a private Greek hospital from 2016-2020. Out of 60 lesions, standard ESD was applied for 54 and enucleation for 6; 41 were mucosal and 19 submucosal; 3 esophageal, 24 gastric, one duodenal, 12 colonic, and 20 rectal. Results Pathology revealed carcinoma (n=14), neuroendocrine tumor (n=7), precancerous lesion (n=27), or other submucosal tumors (n=12). The rates of en bloc and R0 resection were 98% and 91%, respectively. The median resection speed was <3 cm 2 /h for the first 20 cases, but improved progressively to ≥9 cm 2 /h after 40 cases. Two patients underwent laparoscopic surgery for colonic perforation, and one received a blood transfusion because of delayed bleeding (serious adverse event rate: 5%). No deaths occurred. The median hospital stay was 1.3 days. Variables associated with improvement in ESD speed during the second period of the study were the application of countertraction and the experience acquired through other endosurgical techniques. Conclusions ESD was safe and effective in a low-volume center, with an acceptable adverse events rate. At least 40 mixed cases were needed to achieve a high resection speed. Additive experience gained through other endosurgical procedures probably contributed to the improvement in performance.

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Section: Methodsmentioning

confidence: 99%

The learning experience for endoscopic submucosal dissection in a non-academic western hospital: a single operator’s untutored, prevalence-based approach

Mavrogenis¹,

Ntourakis

Wang

et al. 2021

aog

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“…[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. As shown in the video (Video 1, available online at www.VideoGIE.org), colonoscopy revealed a pedunculated appendiceal polyp with a stalk extending from the interior of the appendix (Fig.…”

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confidence: 99%

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

et al. 2021

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“…Low-grade dysplasia was detected in mucosal biopsies. ESD with dynamic clip and band countertraction [ 2 ] was performed and the abnormality was excised. The specimen measured 7.6 cm × 7 cm in size, and histopathology demonstrated multifocal low and high-grade dysplasia with negative margins.…”

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confidence: 99%

“…In case 2, a 60-year-old male was found to have a low grade dysplastic lesion at the lesser curvature, extending towards the incisura and proximal antrum. Multifocal clip and band ESD was applied [ 2 ], and the lesion was excised en bloc ( Fig. 2 ).…”

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confidence: 99%

“…These 2 cases illustrate the feasibility of wide-field whole-antral and whole-incisura ESD for extensive dysplastic areas. Despite the necessity for technical expertise, this technique can be facilitated by the application of ancillary techniques, such as dynamic and multifocal countertraction, as previously described by our team [ 2 , 3 ]. En-bloc resection offers obvious advantages in terms of decreasing recurrence risk, and obviating repeat interventions.…”

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Wide-field endoscopic submucosal dissection for whole-antral and whole-incisura gastric multifocal dysplasia

Mavrogenis¹,

Bazerbachi

Kokolas³

et al. 2021

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Dynamic and multifocal clip and band countertraction for endoscopic submucosal dissection

Cited by 7 publications

References 11 publications

The learning experience for endoscopic submucosal dissection in a non-academic western hospital: a single operator’s untutored, prevalence-based approach

The learning experience for endoscopic submucosal dissection in a non-academic western hospital: a single operator’s untutored, prevalence-based approach

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

Wide-field endoscopic submucosal dissection for whole-antral and whole-incisura gastric multifocal dysplasia

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