High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

Abstract

Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band. Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017. Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators. Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.

Double-tunneling butterfly method for endoscopic submucosal dissection of extensive rectal neoplasms

“…The use of countertraction strategies appears to increase efficiency in ESD both in vivo and ex vivo. 14,15 However, in those studies, lesions in the rectum were excluded, and the mean lesion size was smaller than the size of the lesions we resected in this case series. We recommend the DoT butterfly method for selected patients with extensive rectal lesions that are at least 6 cm in diameter and occupy >60% of the luminal circumference, where there is a higher risk of rolling of the mucosal flap.…”

ESD with double clips and rubber band traction of neoplastic lesions developed in the appendiceal orifice is effective and safe

“…3, ▶ Fig. 4) [7] First, after submucosal injection, a complete circumferential incision and deep trimming were performed. Second, we placed the traction system (composed of two clips and a rubber band).…”

Endoscopic submucosal dissection using countertraction with clips and rubber band allows safe en bloc resection of recurrent duodenal superficial lesions with intense fibrosis

“…Hybrid endoscopic resection was attempted but impossible due to severe submucosal fibrosis. We therefore performed ESD using the clip and rubber band traction technique (▶ Video 1) [3,4]. We closed the duodenal scar using clips and the patient was discharged after 48 hours of follow-up.…”