CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(09): E1187-E1191
DOI: 10.1055/a-0961-7542
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Usefulness of “Nelaton Attachment” for endoscopic submucosal dissection of colorectal neoplasms

Taiji Yoshimoto
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Hiroshi Takihara
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Tomoatsu Yoshihara
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Taro Inoue
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Kohei Ishibashi
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Masanao Uraoka
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Akihiro Nakamura
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Shinsuke Hiramatsu
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Shinichi Baba
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Shun Abe
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Ko Matsuura
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Masato Hoshikawa
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Rika Taketani
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Hironori Tanaka
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Kenichiro Motozato
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Yuji Tanigawa
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Eisuke Nakao
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Akitaka Yokomura
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Michihito Kono
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Kenji Kagari
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Akito Furuta
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Asuka Sunada
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Kenji Maejima
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Eri Tsuyuguchi
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Yasuo Yamasaki
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
,
Takahiro Shishimoto
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted 05. September 2018

accepted after revision 12. März 2019

Publikationsdatum:
29. August 2019 (online)

Abstract

Background and study aims Although colorectal endoscopic submucosal dissection (ESD) has enabled high en bloc resection rates regardless of tumor size, colorectal ESD is still a challenging procedure. We developed a novel device called the Nelaton Attachment, which allows endoscopists to manipulate the ESD knives using two fingers of their left hand while holding the endoscope with their right hand. We retrospectively investigated the efficacy and safety of the Nelaton Attachment for colorectal ESD. We compared efficacy and safety between Nelaton Attachment and non-Nelaton Attachment groups, and also conducted an ex vivo experiment to evaluate the effect of the Nelaton Attachment.

Patients and methods We retrospectively reviewed 36 consecutive patients with 37 colorectal tumors who had undergone ESD at Kishiwada Tokushukai Hospital and Naritatomisato Tokushukai Hospital between April 2016 and September 2018. The Nelaton Attachment was used for 22 of the 37 colorectal ESDs. In the ex vivo experiment, endoscopists inserted and withdrew an ESD knife 2 cm using two fingers of their left hand with and without the Nelaton Attachment.

Results Median procedure time was significantly shorter in the Nelaton Attachment group (38 min [range 6 – 195 min]) compared to the non-Nelaton Attachment group (75 min [range 17 – 198 min]; P = 0.030). Median time to complete the ex vivo experiment five times was significantly faster with the Nelaton Attachment than without the Nelaton Attachment (P = 0.001).

Conclusions Use of the Nelaton Attachment for colorectal ESD is feasible and safe, and may facilitate colorectal ESD procedures.

 
  • References

  • 1 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 58: 1727-1736
  • 2 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
  • 3 Saito Y, Fukuzawa M, Matsuda T. et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010; 24: 343-352
  • 4 Oka S, Tanaka S, Kanao H. et al. Current status in the occurrence of postoperative bleeding, perforation and residual/local recurrence during colonoscopic treatment in Japan. Dig Endosc 2010; 22: 376-380
  • 5 Niikura R, Yasunaga H, Yamada A. et al. Factors predicting adverse events associated with therapeutic colonoscopy for colorectal neoplasia: a retrospective nationwide study in Japan. Gastrointest Endosc 2016; 84: 971-982
  • 6 Nishizawa T, Uraoka T, Suzuki H. et al. Control of the treatment device for endoscopy by the left hand: two-fingers method. Gastrointest Endosc 2014; 80: 1206-1207
  • 7 Yoshimoto T, Takihara H, Yoshihara T. Usefulness of a novel device (Nelaton Attachment) for the two-fingers method during colorectal endoscopic submucosal dissection. Dig Endosc 2018; 30: 523
  • 8 Takeuchi Y, Uedo N, Ishihara R. et al. Efficacy of an endo-knife with a water-jet function (Flushknife) for endoscopic submucosal dissection of superficial colorectal neoplasms. Am J Gastroenterol 2010; 105: 314-322
  • 9 Ohara Y, Toyonaga T, Hoshi N. et al. Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection. World J Gastroenterol 2017; 23: 1657-1665
  • 10 Yoshida N, Toyonaga T, Murakami T. et al. Efficacy of a novel narrow knife with water jet function for colorectal endoscopic submucosal dissection. Gastroenterol Res Pract 2017; 2017: 5897369
  • 11 Kikuchi D, Yamada A, Iizuka T. et al. A new device for simultaneous manipulation of an endoscope and a treatment device during procedures: an ex vivo animal study. Endoscopy 2014; 46: 977-980
  • 12 Kikuchi D, Kuribayashi Y, Iizuka T. et al. Ex vivo comparison study of Smart Shooter®, a new endoscopic device for safe and speedy treatment. Digestion 2015; 91: 26-29
  • 13 Kikuchi D, Iizuka T, Yamada A. et al. Feasibility of a newly developed thumb control device for simultaneous manipulation of the endoscope and treatment devices in endoscopic submucosal dissection: A clinical feasibility study. Digestion 2016; 94: 123-128