“String-to-ring” traction technique for endoscopic submocosal dissection in the treatment of rectal tumors
https://doi.org/10.31146/1682-8658-ecg201-5-97-102
Abstract
The results for “string-to-ring” ESD and conventional ESD were compared in present study. The “string-to-ring” method was developed to create traction using a thread, fixed to the edge of the tumor, that is moved through a ring, located on the clip on the opposite wall. The study included 41 ESDs of the lesions larger than 3 cm in the rectum, that were performed from October 2016 to June 2021. Patients were divided into two groups (“string-to-ring” ESD, n = 19; conventional ESD, n = 22). Time of the procedure and the frequency of complications were evaluated.
Analyzing the obtained data, the “string-to-ring” method allowed to shorten the operation time (from 85,8 ± 17,5 to 63,6 ± 15,3 min), reduce the rate of intraoperative bleeding and perforations from 19% to 0%.
At the conclusion, ESD with “string-to-ring” traction—a promising technique with potential for clinical application. The advantage of this method provide better visualizing the submucosal layer due to the direction of gravity. This method facilitates ESD, reduces procedure time and the number of intraoperative complications—bleeding and perforation.
About the Authors
A. A. Mitrakov
Regional Nizhniy Novgorod State Oncological Hospital; Privolzhsky Research Medical University
Russian Federation
Russian Federation
Alexandr A. Mitrakov, Chief of Endoscopy
603093, Nizhny Novgorod, st. Rodionova, build.190
603005, Nizhny Novgorod, pl. Minin and Pozharsky, build.10/1
S. S. Pirogov
P. A. Herzen Moscow Cancer Research Institute, branch of National Medical Research Radiology Center
Russian Federation
Russian Federation
Sergey S. Pirogov, M.D., Ph. D. Head of endoscopy division
125284, Moscow, 2nd Botkinskiy proezd, build.3
N. N. Mitrakova
Privolzhsky Research Medical University
Russian Federation
Russian Federation
Nina N. Mitrakova, MD, Phd, Chief of Endoscopy learning Center “Endoscopy.PRO”
603005, Nizhny Novgorod, pl. Minin and Pozharsky, build.10/1
S. V. Gamayunov
Regional Nizhniy Novgorod State Oncological Hospital; A. Tsyb Medical Radiological Research Center — branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation (A. Tsyb MRRC)
Russian Federation
Russian Federation
Sergey V. Gamayunov, Ph.D., Head; Visiting Fellow Unit
603093, Nizhny Novgorod, st. Rodionova, build.190
249036, Kaluga region, Obninsk, Korolev str., build. 4
M. V. Timoshchenko
Privolzhsky Research Medical University
Russian Federation
Russian Federation
Michail V. Timoshchenko, resident
603005, Nizhny Novgorod, pl. Minin and Pozharsky, build.10/1
R. A. Gagaev
Regional Nizhniy Novgorod State Oncological Hospital; Privolzhsky Research Medical University
Russian Federation
Russian Federation
Roman A. Gagaev, Endoscopy Unit
603093, Nizhny Novgorod, st. Rodionova, build.190
603005, Nizhny Novgorod, pl. Minin and Pozharsky, build.10/1
References
1. Uraoka T., Saito Y., Matsuda T., et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006;55(11):1592–1597. doi:10.1136/gut.2005.087452
2. Nomura T., Kamei A., Sugimoto S., Oyamada J. Colorectal endoscopic submucosal dissection using the “dental floss with rubber band method”. Endoscopy. 2018;50(3): E78-E80. doi:10.1055/s-0043–124866
3. Parra-Blanco A., Nicolas D., Arnau M. R., Gimeno-Garcia A.Z., Rodrigo L., Quintero E. Gastric endoscopic submucosal dissection assisted by a new traction method: the clip-band technique. A feasibility study in a porcine model (with video). Gastrointest Endosc. 2011;74(5):1137–1141. doi:10.1016/j.gie.2011.07.037
4. Marín-Gabriel J.C., Fernández-Esparrach G., Díaz-Tasende J., Herreros de Tejada A. Colorectal endoscopic submucosal dissection from a Western perspective: Today’s promises and future challenges. World J Gastrointest Endosc. 2016;8(2):40–55. doi:10.4253/wjge.v8.i2.40
5. Chen P.J., Chu H. C., Chang W. K., Hsieh T. Y., Chao Y. C. Endoscopic submucosal dissection with internal traction for early gastric cancer (with video). Gastrointest Endosc. 2008;67(1):128–132. doi:10.1016/j.gie.2007.07.021
6. Ferlitsch M., Moss A., Hassan C., et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2017;49(3):270–297. doi:10.1055/s-0043–102569
7. Nomura T., Kamei A., Sugimoto S., Oyamada J. Colorectal endoscopic submucosal dissection using the “dental fl oss with rubber band method”. Endoscopy. 2018;50(3): E78-E80. doi:10.1055/s-0043–124866
8. Ono H., Kondo H., Gotoda T., et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48(2):225–229. doi:10.1136/gut.48.2.225
9. Ritsuno H., Sakamoto N., Osada T., et al. Prospective clinical trial of traction device- assisted endoscopic submucosal dissection of large superfi cial colorectal tumors using the S-O clip. Surg Endosc. 2014;28(11):3143–3149. doi:10.1007/s00464–014–3572–0
10. Taku K., Sano Y., Fu K. I., et al. Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol. 2007;22(9):1409–1414. doi:10.1111/j.1440–1746.2007.05022.x
11. Tanaka S., Kashida H., Saito Y., et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27(4):417–434. doi:10.1111/den.12456
12. Tomiki Y., Ishiyama S., Sugimoto K., et al. Colorectal endoscopic submucosal dissection by using latex-band traction. Endoscopy. 2011;43 Suppl 2 UCTN: E250-E251. doi:10.1055/s-0030–1256513
13. Tziatzios G., Ebigbo A., Gölder S. K., Probst A., Messmann H. Methods that Assist Traction during Endoscopic Submucosal Dissection of Superfi cial Gastrointestinal Cancers: A Systematic Literature Review. Clin Endosc. 2020;53(3):286–301. doi:10.5946/ce.2019.147
14. Mori H., Kobara H., Nishiyama N., Fujihara S., Matsunaga T., Masaki T. Novel eff ective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection. Surg Endosc. 2017;31(7):3040–3047. doi:10.1007/s00464–016–5326–7
15. Watanabe T., Muro K., Ajioka Y., et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2018;23(1):1–34. doi:10.1007/s10147–017–1101–6
Review
For citations:
Mitrakov A.A., Pirogov S.S., Mitrakova N.N., Gamayunov S.V., Timoshchenko M.V., Gagaev R.A. “String-to-ring” traction technique for endoscopic submocosal dissection in the treatment of rectal tumors. Experimental and Clinical Gastroenterology. 2022;(5):97-102. (In Russ.) https://doi.org/10.31146/1682-8658-ecg201-5-97-102
Views:
245
Email this article 