THE OPENING OF THE ILEOCAECAL VALVE THANKS TO COUNTERTRACTION USING A DOUBLE CLIP AND RUBBER BAND FACILITATES R0 EN BLOC RESECTION OF ILEOCAECAL LSTS

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.

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

Endoscopy ◽

10.1055/a-1144-2611 ◽

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

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

Endoscopy International Open ◽

10.1055/a-1072-4830 ◽

2020 ◽

Vol 08 (03) ◽

pp. E388-E395 ◽

Cited By ~ 4

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.

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

Endoscopy ◽

10.1055/s-0043-122387 ◽

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.

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