| Theme |
Colorectal endoscopic submucosal dissection |
| Title |
Safe ESD technique for colorectal tumors -- using attachment device combined with water jet tube |
| Author |
Yoshiro Tamegai |
Department of Gastroenterology, International Medical Center of Japan |
| Author |
Yuko Nagaoki |
Department of Gastroenterology, International Medical Center of Japan |
| Author |
Takao Ooshima |
Department of Gastroenterology, International Medical Center of Japan |
| Author |
Yuzo Yago |
Department of Gastroenterology, International Medical Center of Japan |
| Author |
Masatoshi Imamura |
Department of Gastroenterology, International Medical Center of Japan |
| Author |
Naohiko Masaki |
Department of Gastroenterology, International Medical Center of Japan |
| Author |
Naomi Uemura |
Department of Gastroenterology, International Medical Center of Japan |
| Author |
Yukio Saito |
Department of Surgery, International Medical Center of Japan |
| Author |
Emiko Takeshita |
Department of Surgery, International Medical Center of Japan |
| Author |
Ooki Miyake |
Department of Surgery, International Medical Center of Japan |
| Author |
Huminori Mihara |
Department of Surgery, International Medical Center of Japan |
| [ Summary ] |
Endoscopic submucosal dissection (ESD) is an en bloc resection method, which may be performed without dividing tumors, making it compatible with the basic concepts of tumor surgery. It was possible to perform ESD on large colorectal tumors with serious complications by using an attachment device combined with a water jet tube. Clinical outcomes for colorectal tumors, using this device are reported on. The indications for ESD are as follows : first, tumors larger than 20 mm in diameter. secondly, pit pafterns in type III1, IIIs, IV or V1 (Low grade) tumors (mucosal or minimally submucosal invasive cancers). thirdly, tumors without V1 (High grade) or VN pit pafterns or non-lifting signs. ESD was performed in 103 lesions in 101 patients (62 male, 39 female, mean age : 65.7 years old). Clinical features of the 103 lesions were as follows, average size 30.6 mm (13-80 mm) and operation time 52.7 minutes (7-164 minutes). One case with complications due to perforation (0.97 %) was seen with ESD and was treated using endoclip closure. No recurrent tumors were found. In this series, the above-mentioned device was used in order to obtain a clear endoscopic view. This hand-made device is simple and very useful in completing ESD by maintaining a good operating field. The safety of ESD has gradually increased. With the development of this device and associated techniques, ESD will play an important role in therapeutic strategies for colorectal tumors. |