scholarly journals Ileocecal valve opening with double clip and rubber band for countertraction facilitates R0 en bloc resection of laterally spreading tumors

Endoscopy ◽  
2020 ◽  
Vol 52 (11) ◽  
pp. E390-E391
Author(s):  
Timothée Wallenhorst ◽  
Mathieu Pioche ◽  
Guillaume Bouguen ◽  
Sylvain Mottais ◽  
David Cocaign ◽  
...  
Keyword(s):  
Ileocecal Valve ◽  
Rubber Band ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Valve Opening ◽  
Laterally Spreading Tumors

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

2019 ◽  
Vol 07 (09) ◽  
pp. E1166-E1174 ◽  
Author(s):  
Jérémie Jacques ◽  
Aurélie Charissoux ◽  
Pierre Bordillon ◽  
Romain Legros ◽  
Jérôme Rivory ◽  
...  
Keyword(s):  
Case Series ◽  
Rubber Band ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Point Of View ◽  
University Hospital ◽  
Control Group ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc

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.

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

Endoscopy ◽  
2020 ◽  
Vol 52 (11) ◽  
pp. E398-E399
Author(s):  
Alexandru Lupu ◽  
Julien Faller ◽  
Borathchakra Oung ◽  
Timothée Wallenhorst ◽  
Jérémie Jacques ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Rubber Band ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Dissection

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

2020 ◽  
Vol 08 (03) ◽  
pp. E388-E395 ◽  
Author(s):  
Borathchakra Oung ◽  
Jérôme Rivory ◽  
Edouard Chabrun ◽  
Romain Legros ◽  
Julien Faller ◽  
...  
Keyword(s):  
Rubber Band ◽  
En Bloc Resection ◽  
Lesion Size ◽  
Bloc Resection ◽  
R0 Resection ◽  
Incomplete Resection ◽  
En Bloc ◽  
Close Proximity ◽  
Traction System ◽  
Type 3

Abstract Background and study aims Endoscopic submucosal dissection (ESD) of superficial colorectal lesions in close proximity to the appendiceal orifice (L-PAO) was shown to be feasible except in case of deep invasion into the appendix (type 3 of Toyonaga’s classification). This study aimed to determine the outcomes of ESD with double clip and rubber band traction (DCT-ESD) of L-PAO including a majority of type 3. Patients and methods We reviewed retrospectively all consecutive DCT-ESD of L-PAO performed in 3 French centers. Each lesion was described according to Toyonaga’s classification and type 0 lesions were excluded. The primary outcome was en bloc and R0 resection rates for L-PAO. Morbidity and salvage surgery were recorded. Results A total of 32 patients underwent DCT-ESD; 22 lesions (68.8 %) were type 3, including 11 with previous appendectomy (34.4 %). Median lesion size was 35 mm range (10–110 mm) and median duration of resection was 47 min range (10–230 min). We achieved 100 % of En bloc resection exclusively with DCT-ESD and 90.6 % of histological R0 resection rate. Per-procedure, 11 perforations occurred and were all immediately closed with clips. Overall, 3 patients (10.7 %) underwent surgery without stoma (2 complications related and 1 incomplete resection). No death occurred. Conclusion ESD of lesions deeply invading appendiceal orifice is feasible with the help of a traction system. Technical success by endoscopy avoiding surgery was achieved in 90.6 % of cases.

scholarly journals Two-step ESD: an option for en-bloc resection of extensive colorectal laterally spreading tumors

2019 ◽  
Vol 07 (09) ◽  
pp. E1092-E1096
Author(s):  
Fabio S. Kawaguti ◽  
Ossamu Okazaki ◽  
Nelson T. Miyajima ◽  
Vanderlei Segateli ◽  
Carlos F.S. Marques ◽  
...  
Keyword(s):  
Curative Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Second Step ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Mean Size ◽  
One Step ◽  
Second Procedure ◽  
Laterally Spreading Tumors

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is considered feasible and safe for treatment of colorectal laterally spreading tumors (LST), However it remains a challenge in case of extensive lesions even for experts. This study aimed to describe a new method to facilitate ESD of extensive colorectal LSTs. Between July 2010 and January 2018, 140 patients underwent ESD for colorectal LSTs. Four of them were submitted to two-step ESD and were included in this retrospective study. The submucosal dissection of lesions larger than 12 cm started and continued until the medical team decided to pause the procedure and continue it in a second step. The second procedure was performed 2 days after to finish the en-bloc resection.Three patients were male, with mean age of 67.2y (± 2.2). All lesions were located in the rectum, with a mean size of 153.7 mm (± 33.8). En-bloc and curative resection were successfully achieved in all cases. Mean duration of the first step of the procedure was 255 minutes (± 61.8), and mean duration of the second step was 205 minutes (± 205). Overall mean duration of both steps was 460 minutes (± 168). Mean dissected area in the first step of the procedure was approximately 55 % of the lesion. No adverse events were observed. In conclusion, our results suggest that performing ESD in two steps could be a feasible and safe option for exceptional cases in which is not possible to finish the procedure in one step, avoiding the morbidity of surgical treatment.

Attempted underwater en bloc resection for large (2-4 cm) colorectal laterally spreading tumors (with video)

2015 ◽  
Vol 81 (3) ◽  
pp. 713-718 ◽  
Author(s):  
Kenneth F. Binmoeller ◽  
Christopher M. Hamerski ◽  
Janak N. Shah ◽  
Yasser M. Bhat ◽  
Steven D. Kane ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Laterally Spreading Tumors

Multiband mucosectomy for the treatment of challenging non-pedunculated colorectal polyps

Endoscopy ◽  
2017 ◽  
Vol 50 (03) ◽  
pp. 253-258
Author(s):  
Joaquín Rodríguez-Sánchez ◽  
Eva De la Santa Belda ◽  
Pilar Olivencia Palomar ◽  
Margarita Úbeda Muñoz ◽  
José Olmedo Camacho
Keyword(s):  
Rubber Band ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
En Bloc ◽  
Small Series ◽  
Resected Tissue ◽  
Cook Medical ◽  
Multiband Mucosectomy

Abstract Background and study aims Endoscopic mucosal resection is the gold standard treatment for non-pedunculated colorectal polyps; however, some specific situations (location behind folds, scarred or flat morphology) can make this technique challenging. We aimed to assess the efficacy and safety of multiband mucosectomy (MBM) for resection of non-pedunculated colorectal polyps. Patients and methods This was a retrospective study of patients in whom MBM was performed to resect large non-pedunculated colorectal polyps. All procedures were carried out using the Shooter multiband ligator kit (Cook Medical, Limerick, Ireland). A 3-month follow-up colonoscopy was performed in all patients. Results 10 patients underwent MBM for resection of 10 large (median 33.5 mm) non-pedunculated polyps. A total of 45 MBM sessions were carried out to resect all of the lesions using on average one rubber band per 1.5 cm2 of resected tissue. Complete resection was possible in 9 out of 10 lesions, although en bloc resection was only feasible in one lesion. Follow-up colonoscopy revealed residual adenoma in just one patient. No major complications were registered. Conclusions In this small series of patients, MBM proved to be a safe and effective endoscopic resection technique for challenging non-pedunculated colorectal polyps.

1080 Giant LST-NG Above the Ileocecal Valve. En Bloc Resection of the Entire Upper Valve

2017 ◽  
Vol 85 (5) ◽  
pp. AB135
Author(s):  
Felipe Ramos Zabala ◽  
Jorge Vásquez Guerrero ◽  
Alejandra P. Alzina ◽  
Domínguez P. Ana ◽  
Marian Garcia ◽  
...  
Keyword(s):  
Ileocecal Valve ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc

Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis

Endoscopy ◽  
2017 ◽  
Vol 50 (03) ◽  
pp. 263-282 ◽  
Author(s):  
Roel Bogie ◽  
Manon Veldman ◽  
Luc Snijders ◽  
Bjorn Winkens ◽  
Tonya Kaltenbach ◽  
...  
Keyword(s):  
Meta Analysis ◽  
En Bloc Resection ◽  
Lesion Size ◽  
Bloc Resection ◽  
Submucosal Invasion ◽  
Cochrane Library ◽  
En Bloc ◽  
Random Effects Models ◽  
Pooled Prevalence ◽  
Laterally Spreading Tumors

Abstract Background and study aims Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment. Methods We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95 % confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes. Results We identified 2949 studies, of which 48 were included. Overall, 8.5 % (95 %CI 6.5 % – 10.5 %) of LSTs contained SMI. The risk of SMI differed among the LST subtypes: 31.6 % in non-granular pseudodepressed LSTs (95 %CI 19.8 % – 43.4 %), 10.5 % in granular nodular mixed LSTs (95 %CI 5.9 % – 15.1 %), 4.9 % in non-granular flat elevated LSTs (95 %CI 2.1 % – 7.8 %), and 0.5 % in granular homogenous LSTs (95 %CI 0.1 % – 1.0 %). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95 %CI 1.24 – 5.02). The proportion of SMI increased with lesion size (10 – 19 mm, 4.6 %; 20 – 29 mm, 9.2 %; ≥ 30 mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8 % (95 %CI 0.6 % – 1.1 %). Conclusion The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the preferred therapy.

scholarly journals Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type

2017 ◽  
Vol 05 (02) ◽  
pp. E123-E129 ◽  
Author(s):  
Hirotsugu Sakamoto ◽  
Yoshikazu Hayashi ◽  
Yoshimasa Miura ◽  
Satoshi Shinozaki ◽  
Haruo Takahashi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Novel Strategy ◽  
Laterally Spreading Tumors ◽  
Severe Fibrosis

Abstract Background and study aims The pocket-creation method (PCM) is a novel strategy for endoscopic submucosal dissection (ESD). The aim of this study is to determine the efficacy of the PCM for colorectal laterally spreading tumors, non-granular type (LST-NG). Patients and methods The records of 126 consecutive patients with colorectal LST-NG who underwent ESD between April 2012 and July 2015 were retrospectively reviewed. Patients were divided into PCM (n = 73) and conventional method (CM) (n = 53) groups. Results The en bloc resection rate in the PCM group was significantly higher than in the CM group (100 % [73/73] vs. 92 % [49/53], P = 0.03). The en bloc resection rate with severe fibrosis was higher in the PCM group than in the CM group (100 % [3/3] vs. 60 % [3/5]). The R0 resection rate for the two groups was not statistically significantly different (93 % [68/73] vs. 91 % [48/53], P = 0.74). The perforation rate in the PCM group was lower than in the CM group although not statistically significantly less (0 % 0/73 vs. 4 % 2/53, P = 0.18). For lesions resected en bloc, dissection speed for the PCM group was significantly faster than for the CM group (median [IQR], 19 [13 –24] vs. 14 [10 – 22] mm2/min, P = 0.03). Conclusion ESD using PCM achieves a reliable and safe resection of colorectal LST-NG.

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