The utility of a novel colonoscope with retroflexion for colorectal endoscopic submucosal dissection

Abstract

Background and study aims The PCF-H290TI/L produced by Olympus is a novel colonoscope equipped with some advantageous features for endoscopic treatment. It is expected to improve the potential for retroflexion and overall endoscope operability, which can reduce the difficulty of performing colorectal ESD. The aim of this study was to evaluate the utility of the novel colonoscope in colorectal ESD.

Methods Three hundred and forty-eight consecutive colorectal lesions resected via ESD between June 2014 and January 2017 at Hiroshima University Hospital were included in the retroflexion ability analysis. We compared the retroflexion potential of PCF-H290TI to that of a conventional endoscope. Two hundred and twenty-seven colorectal lesions located in the left-sided colon and resected with ESD between April 2009 and February 2018 were enrolled in the treatment outcome analysis. Treatment outcomes using PCF-H290TI compared to those of the conventional colonoscope, and outcomes of the PCF-H290TI with retroflexion compared to those of the conventional colonoscope without retroflexion were evaluated by propensity score matching.

Results The retroflexion rate with the PCF-H290TI was 76 %, which was significantly higher than the 44 % rate with the conventional scope. Endoscope operability was better and dissection speed was faster when using the PCF-H290TI with retroflexion compared to the conventional colonoscope without retroflexion. There were no significant differences between the groups in en bloc resection rate and adverse events.

Conclusion Compared to the conventional colonoscope, the PCF-H290TI/L made it easier to perform ESD via a retrograde approach regardless of tumor location, and thus may be useful for performing colorectal ESD.

• References

• 1 Tanaka S, Terasaki M, Kanao H. et al. Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc 2012; 24: 73-79
• 2 Oka S, Tanaka S, Saito Y. et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 2015; 110: 697-707
• 3 Shigita K, Oka S, Tanaka S. et al. Long–term outcomes after endoscopic submucosal dissection for superficial colorectal tumors. Gastrointest Endosc 2017; 85: 546-553
• 4 Boda K, Oka S, Tanaka S. et al. Clinical outcomes of endoscopic submucosal dissection for colorectal tumors: a large multicenter retrospective study from the Hiroshima GI Endoscopy Research Group. Gastrointest Endosc 2018; 87: 714-722
• 5 Asayama N, Oka S, Tanaka S. et al. Long-term outcomes after treatment for T1 colorectal carcinoma. Int J Colorectal Dis 2016; 31: 571-578
• 6 Tamaru Y, Oka S, Tanaka S. et al. Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group. Surg Endosc 2016; 30: 4425-4431
• 7 Tamaru Y, Oka S, Tanaka S. et al. Long–term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group. J Gastroenterol 2017; 52: 1169-1179
• 8 Nakamura F, Saito Y, Haruyama S. et al. Short-term prospective questionnaire study of early postoperative quality of life after colorectal endoscopic submucosal dissection. Dig Dis Sci 2017; 62: 3325-3335
• 9 Asayama N, Oka S, Tanaka S. et al. Endoscopic submucosal dissection as total excisional biopsy for clinical T1 colorectal carcinoma. Digestion 2015; 91: 64-69
• 10 Kim JH, Baek IH, Kim KO. et al. Usefulness and feasibility of endoscopic submucosal dissection for colorectal tumor: a nationwide multicenter retrospective study in Korea. J Gastrointest Oncol 2016; 7: 924-930
• 11 Tanaka S, Asayama N, Shigita K. et al. Towards safer and appropriate application of endoscopic submucosal dissection for T1 colorectal carcinoma as total excisional biopsy: future perspectives. Dig Endosc 2015; 27: 216-222
• 12 Ohata K, Ito T, Chiba H. et al. Effective training system in colorectal endoscopic submucosal dissection. Dig Endosc 2012; 24: 84-89
• 13 Takeuchi Y, Iishi H, Tanaka S. et al. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis 2014; 29: 1275-1284
• 14 Saito Y, Yamada M, Abe S. et al. Colorectal endoscopic submucosal dissection: technical advantages compared to endoscopic mucosal resection and minimally invasive surgery. Dig Endosc 2014; 26: 52-61
• 15 Mizushima T, Kato M, Iwanaga I. et al. Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc 2015; 29: 133-139
• 16 Imai K, Hotta K, Yamaguchi Y. et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc 2016; 83: 954-962
• 17 Kang DU, Choi Y, Lee HS. et al. Endoscopic and clinical factors affecting the prognosis of colorectal endoscopic submucosal dissection–related perforation. Gut Liver 2016; 10: 420-428
• 18 Jeon HH, Lee HS, Youn YH. et al. Learning curve analysis of colorectal endoscopic submucosal dissection (ESD) for laterally spreading tumors by endoscopists experienced in gastric ESD. Surg Endosc 2016; 30: 2422-2430
• 19 Shiga H, Kuroha M, Endo K. et al. Colorectal endoscopic submucosal dissection (ESD) performed by experienced endoscopists with limited experience in gastric ESD. Int J Colorectal Dis 2015; 30: 1645-1652
• 20 Hayashi N, Tanaka S, Nishiyama S. et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc 2014; 79: 427-435
• 21 Vemulapalli KC. REX DK. Retroflexion in colonoscopy: Why? Where? When? How? What value?. Gastroenterology 2013; 144: 882-883
• 22 Pishvaian AC, AI-Kawas FH. Retroflexion in the colon: a useful and safe technique in the evaluation and resection of sessile polyps during colonoscopy. Am J Gastroenterol 2006; 101: 1479-1483
• 23 Rex DK, Khashab M. Colonoscopic polypectomy in retroflexion. Gastrointest Endosc 2006; 63: 144-148
• 24 Liu S, Li Y, Yang H. et al. Retroflexion–assisted endoscopic mucosal resection: a useful and safe method for removal of low rectal laterally spreading tumors. Surg Endosc 2016; 30: 139-146
• 25 Fujihara S, Kobara H, Mori H. et al. Comparison of retroflexed and forward views for colorectal endoscopic submucosal dissection. Int J Med Sci 2015; 12: 450-457
• 26 Terasaki M, Tanaka S, Oka S. et al. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 2012; 27: 734-740
• 27 Matsumoto A, Tanaka S, Oka S. et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010; 45: 1329-1337
• 28 Tajiri H, Kitano S. Complication associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental. Dig Endosc 2004; 16: 134-136
• 29 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
• 30 Tanaka S, Saito Y, Matsuda T. et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol 2015; 50: 252-260
• 31 Asayama N, Oka S, Tanaka S. et al. Clinical usefulness of a single-use splinting tube for poor endoscope operability in deep colonic endoscopic submucosal dissection. Endosc Int Open 2016; 4: E614-E617