Novel Colorectal Endoscopic Submucosal Dissection With Double-Endoscope and Snare-Based Traction

Abstract

BACKGROUND: Colorectal endoscopic submucosal dissection is technically demanding, and the traction offered by gravity, cap, or clip-with-line during conventional endoscopic submucosal dissection remains unsatisfactory. Robotic systems are still under development and are expensive. We proposed double-scope endoscopic submucosal dissection with strong and adjustable traction offered by snaring the lesion with additional scope. OBJECTIVE: This study aimed to test the novel double-scope endoscopic submucosal dissection with snare-based traction. DESIGN: This was a retrospective study that reviewed double-scope endoscopic submucosal dissection compared with matched conventional endoscopic submucosal dissection, and size, location, morphology, and pathology between groups were compared. SETTINGS: This study was conducted in a referral endoscopy center in a local hospital. PATIENTS: This study included patients with colorectal lesions receiving double-scope endoscopic submucosal dissection and matched conventional endoscopic submucosal dissection. MAIN OUTCOME MEASURES: The pathological completeness, procedure time, and complications were analyzed. RESULTS: Fifteen double-scope endoscopic submucosal dissection procedures, with 11 lesions located in the proximal colon with a median size of 40 mm, were performed. The median procedure time of double-scope endoscopic submucosal dissection was 32.45 (interquartile range, 16.03–38.20) minutes. The time required for second scope insertion was 2.57 (interquartile range, 0.95–6.75) minutes; for snaring, 3.03 (interquartile range, 2.12–6.62) minutes; and for actual endoscopic submucosal dissection, 28.23 (interquartile range, 7.90–37.00) minutes. All lesions were resected completely. No major complication was encountered. The procedure time was significantly shorter than that of 14 matched conventional endoscopic submucosal dissections (54.61 [interquartile range, 33.11–97.25] min; p = 0.021). LIMITATIONS: This was a single-center, single-operator, retrospective case-controlled study with limited cases. CONCLUSIONS: This study confirmed the feasibility of double-scope endoscopic submucosal dissection with snare-based traction to shorten procedure time and to simplify endoscopic submucosal dissection. Additional trials are required.

Exploring the landscape of colorectal endoscopic submucosal dissection in Taiwan: In‐depth investigation of complication risks

“…6 With conventional traction methods sometimes falling short, Chou et al introduced a novel double endoscopy ESD with snare traction. 7 The retrospective study showed a median procedure time of 32.45 min for double-scope ESD, significantly shorter than the 54.61 min for matched conventional ESD. All lesions were completely resected without major complications.…”

“…All lesions were completely resected without major complications. 7 Double endoscopy ESD can be used effectively to remove lesions in difficult anatomical areas. 8 Wu et al also proposed that the snare tip is a viable alternative tool for colorectal ESD in a specific population, particularly when specialized ESD knives are unavailable.…”

“…By employing this standardized approach, dissection speed can be enhanced, potentially reducing the likelihood of complications, particularly in cases associated with submucosal fibrosis resulting from prior biopsies 6 . With conventional traction methods sometimes falling short, Chou et al introduced a novel double endoscopy ESD with snare traction 7 . The retrospective study showed a median procedure time of 32.45 min for double‐scope ESD, significantly shorter than the 54.61 min for matched conventional ESD.…”

“…The retrospective study showed a median procedure time of 32.45 min for double‐scope ESD, significantly shorter than the 54.61 min for matched conventional ESD. All lesions were completely resected without major complications 7 . Double endoscopy ESD can be used effectively to remove lesions in difficult anatomical areas 8 .…”

Robotic-assisted vs non-robotic traction techniques in endoscopic submucosal dissection for malignant gastrointestinal lesions

“…In the double-scope traction technique, a second small-caliber endoscope is inserted along with the main endoscope after circumferential resection. By passing a share, net, or forceps through the second endoscope’s channel, and deploying the instrument of interest on the desired edge of tissue undergoing resection, traction can be applied ( 17 ). The primary endoscope is responsible for ESD.…”