Endoscopic Submucosal Dissection of Large Pseudo-Polyps in the Right Colon Using a Novel Articulating Grasper With A Double-Balloon Endolumenal Surgical Platform

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Shinya Urakawa ◽  
Kota Momose ◽  
Yohei Kono ◽  
Teijiro Hirashita ◽  
Makoto Nishimura ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Right Colon ◽  
Double Balloon ◽  
Submucosal Dissection ◽  
The Right ◽  
Surgical Platform

scholarly journals Endoscopic Submucosal Dissection of Pseudo-polyps in the Right Colon Using a Flexible Grasper With Articulating Distal Tip and Elbow-Like Bending

2021 ◽  
Author(s):  
Shinya Urakawa ◽  
Teijiro Hirashita ◽  
Yuka Hirashita ◽  
Lea Lowenfeld ◽  
Krishna Gurram ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
3D Model ◽  
Posterior Wall ◽  
Ascending Colon ◽  
Procedure Time ◽  
Right Colon ◽  
Submucosal Dissection ◽  
Descending Colon ◽  
The Right ◽  
Surgical Platform

Abstract Endoscopic submucosal dissection (ESD) is challenging in the right colon. Traction devices can make it technically easier. In this study, we evaluated a flexible grasper with articulating tip and elbow-like bending (IgE) through a double-balloon surgical platform (DESP), compared with an earlier generation grasper without elbow-like bending (Ig). The reach of Ig/IgE was investigated at eight locations using a synthetic colon within a 3D model. Using a fresh porcine colorectum, 4 cm pseudo-polyps were created at the posterior wall of the ascending colon. Fifty-four ESD procedures were performed using three techniques: standard ESD (STD), ESD using Ig (DESP+Ig), and ESD using IgE (DESP+IgE). IgE was able to reach the full circumference at all the locations, whereas the medial walls proximal to the descending colon were out of Ig’s reach. Compared with the STD, both DESP+Ig and DESP+IgE showed significantly shorter procedure time (STD vs. DESP+Ig vs. DESP+IgE = median 48.9 min vs. 38.6 vs. 29.9) and fewer injuries (1.5 vs. 0 vs. 0). Moreover, the DESP+IgE had a shorter procedure time than the DESP+Ig (p=0.0025). The IgE with DESP increased instrument reach compared to Ig, and likely represented a traction tool for excision of large pseudo-polyps in the right colon.

scholarly journals Endoscopic submucosal dissection of a laterally spreading tumor in the right colon with a gastroscope after shortening the colon using a new double-balloon platform

Endoscopy ◽  
2019 ◽  
Vol 51 (12) ◽  
pp. E364-E365
Author(s):  
Jérémie Jacques ◽  
Jérémie Albouys ◽  
Anne Guyot ◽  
Sophie Geyl ◽  
Romain Legros ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Right Colon ◽  
Laterally Spreading Tumor ◽  
Double Balloon ◽  
Submucosal Dissection ◽  
The Right

scholarly journals Effectiveness of S-O Clip-Assisted Colorectal Endoscopic Submucosal Dissection

2021 ◽  
Vol 11 (1) ◽  
pp. 141
Author(s):  
Haruka Fujinami ◽  
Akira Teramoto ◽  
Saeko Takahashi ◽  
Takayuki Ando ◽  
Shinya Kajiura ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
Right Colon ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection ◽  
The Right ◽  
Surgery Duration

This study aimed to assess the utility of the S-O clip during colorectal endoscopic submucosal dissection (ESD). We conducted a retrospective study on 185 patients who underwent colorectal ESD from January 2015 to January 2020. The patients were divided into two groups: before and after the introduction of the S-O clip. Forty-two patients underwent conventional ESD (CO group) and 29 patients underwent ESD using the S-O clip (SO group). We compared the surgery duration, dissection speed, en bloc resection rate, and complication rate between both groups. Compared with the CO group, the SO group had a significantly shorter surgery duration (70.7 ± 37.9 min vs. 51.2 ± 18.6 min; p = 0.017), a significantly higher dissection speed (15.1 ± 9.0 min vs. 26.3 ± 13.8 min; p < 0.001), a significantly higher en bloc resection rate (80.9% vs. 98.8%; p ≤ 0.001), and a significantly lower perforation rate (4.3% vs. 1.3%). In the right colon, the surgery duration was significantly shorter and the dissection speed was significantly higher in the SO group than in the CO group. Moreover, the rate of en bloc resection improved significantly in the right colon. S-O clip-assisted ESD reduces the procedure time and improves the treatment effects, especially in the right colon.

scholarly journals Use of an endoscopic flexible grasper as a traction tool for excision of polyps: preclinical trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinya Urakawa ◽  
Teijiro Hirashita ◽  
Yuka Hirashita ◽  
Lea Lowenfeld ◽  
Krishna C. Gurram ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
3D Model ◽  
Posterior Wall ◽  
Ascending Colon ◽  
Procedure Time ◽  
Right Colon ◽  
Preclinical Trial ◽  
Descending Colon ◽  
The Right ◽  
Surgical Platform

AbstractEndoscopic submucosal dissection (ESD) is challenging in the right colon. Traction devices can make it technically easier. In this study, we evaluated a flexible grasper with articulating tip and elbow-like bending (IgE) through a double-balloon surgical platform (DESP), compared with an earlier generation grasper without elbow-like bending (Ig). The reach of Ig/IgE was investigated at eight locations using a synthetic colon within a 3D model. Using a fresh porcine colorectum, 4 cm pseudo-polyps were created at the posterior wall of the ascending colon. Fifty-four ESD procedures were performed using three techniques: standard ESD (STD), ESD using Ig (DESP + Ig), and ESD using IgE (DESP + IgE). IgE was able to reach the full circumference at all the locations, whereas the medial walls proximal to the descending colon were out of Ig’s reach. Compared with the STD, both DESP + Ig and DESP + IgE showed significantly shorter procedure time (STD vs. DESP + Ig vs. DESP + IgE = median 48.9 min vs. 38.6 vs. 29.9) and fewer injuries (1.5 vs. 0 vs. 0). Moreover, the DESP + IgE had a shorter procedure time than the DESP + Ig (p = 0.0025). The IgE with DESP increased instrument reach compared to Ig, and likely represented a traction tool for excision of large pseudo-polyps in the right colon.

scholarly journals Endoscopic submucosal dissection of early gastric cancer via inverted overtube in a patient with situs inversus totalis: a case report

2018 ◽  
Vol 06 (05) ◽  
pp. E625-E629
Author(s):  
Youichi Miyaoka ◽  
Shinsuke Suemitsu ◽  
Aya Fujiwara ◽  
Satoshi Kotani ◽  
Kosuke Tsukano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Situs Inversus ◽  
Gastric Fluid ◽  
Situs Inversus Totalis ◽  
Endoscopic View ◽  
Submucosal Dissection ◽  
The Right ◽  
Lesser Curvature

Abstract Background and study aims A 72-year-old man with complete situs inversus presented with early gastric cancer on the lesser curvature wall of the antrum of the stomach. Endoscopic submucosal dissection (ESD) was selected as a treatment. When the patient was positioned in the left decubitus position, the lesion was hidden by blood and gastric fluid because it was located on the gravitational side. Therefore, we decided to perform ESD with the patient in the right lateral decubitus position and use an inverted overtube, which provided a good endoscopic view without the need to rearrange the endoscopist, assistants, or endoscopic system. ESD was safe and feasible using the inverted overtube.

scholarly journals Effectiveness and risk factors of endoscopic submucosal dissection for right colon neoplasms

2020 ◽  
Vol 179 (4) ◽  
pp. 29-35
Author(s):  
E. A. Khomyakov ◽  
D. A. Mtvralashvili ◽  
Yu. E. Vaganov ◽  
S. V. Chernyshov ◽  
O. M. Iugai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Endoscopic Submucosal Dissection ◽  
Local Excision ◽  
Lateral Spreading ◽  
Right Colon ◽  
Colon Neoplasms ◽  
Submucosal Dissection

Introduction. Endoscopic submucosal dissection (ESD) is a standard method of local excision of benign colon tumors. Nevertheless, it is not widely used because of its technical difficulty and risk of complication especially in right colon. The OBJECTIVE was to improve the results of treatment of patients with right colon neoplasms.Methods and materials. The results of 152 consecutive patients (median age 66 years, 88 female) with lateral spreading tumors (LST) were analyzed. Logistic regression was performed to evaluate risk factors of conversion and complications.Results. ESD as planned performed in 133 out of 152 patients. Conversion to bowel resection occurred in 19 cases. In the logistic regression model, lifting less than 3 mm (p=0.034) was independent risk factor of the conversion. Postoperative complications up to 30 days occurred in 5 out of 133 (3.8 %) of patients underwent ESD. There was no mortality after ESD. Severe fibrosis the base of the neoplasm was the only risk factor of postoperative complications (95 % CI=1.0—1.2; p=0.007). Final pathology revealed that 127 out of 133 patients (95.5 %) had adenomas and 6 out of 133 (4.5 %) patients had early adenocarcinomas. R0 resections was performed in 94/133 (70.7 %) cases.Conclusions. ESD is the safe and efficient method of local excision of benign right colon neoplasms. Unfavorable lifting (p=0.05) and submucosal fibrosis (p=0.007) are risk factors of ESD failure.

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