Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(03): E437-E444
DOI: 10.1055/a-1093-0681
Original article

Clinical usefulness of the S-O clip during colorectal endoscopic submucosal dissection in difficult-to-access submucosal layer

Yuki Okamoto
1   Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
,
Shiro Oka
1   Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
,
Shinji Tanaka
2   Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
,
Katsuaki Inagaki
1   Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
,
Hidenori Tanaka
1   Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
,
Kenta Matsumoto
1   Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
,
Kazuki Boda
1   Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
,
Ken Yamashita
1   Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
,
Kyoku Sumimoto
2   Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
,
Yuki Ninomiya
2   Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
,
Kazuaki Chayama
1   Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims In colorectal endoscopic submucosal dissection (ESD), the S-O clip improves the accessibility to the submucosal layer of the colon. However, its safety and usefulness in difficult colorectal ESDs are unclear. Thus, in this study, we aimed to assess the effectiveness of the S-O clip in colorectal ESD in the difficult-to-access submucosal layer.

Patients and methods From January 2016 to December 2016, 189 consecutive cases of colorectal ESD were performed at Hiroshima University Hospital before the S-O clip was introduced. Between January 2017 and June 2018, among 271 consecutive colorectal ESD cases, 41 cases were performed colorectal ESD using the S-O clip. We compared outcomes between the two groups (41 cases with S-O clip [use group] and 189 cases without S-O clip [non-use group]) using propensity score matching.

Results Prior to propensity score matching, 41 cases with the S-O clip (use group) and 189 cases without the S-O clip (non-use group) were extracted. The degree of submucosal fibrosis was more severe and the procedure time was longer in the use group than in the non-use group. In the use and non-use groups, en bloc resection (100 % vs. 94.7 %) and complete en bloc resection (100 % vs. 92.6 %) rates were satisfactory. After propensity score matching, 33 cases in each group were extracted. As a result, complete en bloc resection rate was significantly higher in the use group than in the non-use group (100 % vs. 84.9 %).

Conclusion The S-O clip is effective and can be used safely in colorectal ESD in the difficult-to-access submucosal layer.



Publication History

Received: 04 June 2019

Accepted: 11 September 2018

Article published online:
21 February 2020

© 2020. Owner and Copyright ©

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Tanaka S, Oka S, Kaneko I. et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 2007; 66: 100-107
    CrossrefPubMedSearch in Google Scholar
  • 2 Tamegai Y, Saito Y, Masaki N. et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 2007; 39: 418-422
    Thieme ConnectPubMedSearch in Google Scholar
  • 3 Hurlstone DP, Atkinson R, Sanders DS. et al. Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg 2007; 94: 1536-1542
    CrossrefPubMedSearch in Google Scholar
  • 4 Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 2008; 43: 641-651
    CrossrefPubMedSearch in Google Scholar
  • 5 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
    CrossrefPubMedSearch in Google Scholar
  • 6 Tanaka S, Tamegai Y, Tsuda S. et al. Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan. Dig Endosc 2010; 22: S2-S8
    CrossrefPubMedSearch in Google Scholar
  • 7 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
    CrossrefPubMedSearch in Google Scholar
  • 8 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
    CrossrefPubMedSearch in Google Scholar
  • 9 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
    CrossrefPubMedSearch in Google Scholar
  • 10 Matsumoto A, Tanaka S, Oba S. et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010; 45: 1329-1337
    CrossrefPubMedSearch in Google Scholar
  • 11 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
    CrossrefPubMedSearch in Google Scholar
  • 12 Lee BI. Debates on colorectal endoscopic submucosal dissection – traction for effective dissection: gravity is enough. Clin Endosc 2013; 46: 467-471
    CrossrefPubMedSearch in Google Scholar
  • 13 Saito Y, Emura F, Matsuda T. et al. A new sinker-assisted endoscopic submucosal dissection for colorectal cancer. Gastrointest Endosc 2005; 62: 297-301
    CrossrefPubMedSearch in Google Scholar
  • 14 Yamamoto K, Hayashi S, Saiki H. et al. Endoscopic submucosal dissection for large superficial colorectal tumors using the “clip-flap method”. Endoscopy 2015; 47: 262-265
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Imaeda H, Hosoe N, Ida Y. et al. Novel technique of endoscopic submucosal dissection by using external forceps for early rectal cancer (with videos). Gastrointest Endosc 2012; 75: 1253-1257
    CrossrefPubMedSearch in Google Scholar
  • 16 Uraoka T, Kato J, Ishikawa S. et al. Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos). Gastrointest Endosc 2007; 66: 836-839
    CrossrefPubMedSearch in Google Scholar
  • 17 Uraoka T, Ishikawa S, Kato J. et al. Advantages of using thin endoscope-assisted endoscopic submucosal dissection technique for large colorectal tumors. Dig Endosc 2010; 22: 186-191
    CrossrefPubMedSearch in Google Scholar
  • 18 Yamasaki Y, Takeuchi Y, Hanaoka N. et al. A novel traction method using an endoclip attached to a nylon string during colonic endoscopic submucosal dissection. Endoscopy 2015; 47: E238-E239
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Yamasaki Y, Takeuchi Y, Uedo N. et al. Traction-assisted colonic endoscopic submucosal dissection using clip and line: a feasibility study. Endosc Int Open 2016; 4: E51-E55
    PubMedSearch in Google Scholar
  • 20 Ota R, Doyama H, Tsuji K. et al. Deep colonic endoscopic submucosal dissection using a modified clip and snare method incorporating a pre-looping technique. BMJ Case Rep 2015; pii: bcr2014207918
    PubMedSearch in Google Scholar
  • 21 Yamada S, Doyama H, Ota R. et al. Impact of the clip and snare method using the prelooping technique for colorectal endoscopic submucosal dissection. Endoscopy 2016; 48: 281-285
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Gotoda T, Oda I, Tamakawa K. et al. Prospective clinical trial of magnetic-anchor-guided endoscopic submucosal dissection for large early gastric cancer (with videos). Gastrointest Endosc 2009; 69: 10-15
    CrossrefPubMedSearch in Google Scholar
  • 23 Sakamoto N, Osada T, Shibuya T. et al. The facilitation of a new traction device (S-O clip) assisting endoscopic submucosal dissection for superficial colorectal neoplasms. Endoscopy 2008; 40: E94-E95
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Sakamoto N, Osada T, Shibuya T. et al. Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction (with video). Gastrointest Endosc 2009; 69: 1370-1374
    CrossrefPubMedSearch in Google Scholar
  • 25 Nagata M. Modified attachment method using an S-O clip for gastric endoscopic submucosal dissection. VideoGIE 2019; 4: 151-153
    CrossrefPubMedSearch in Google Scholar
  • 26 Hashimoto R, Hirasawa D, Iwaki T. et al. Usefulness of the S-O clip for gastric endoscopic submucosal dissection (with video). Surg Endosc 2018; 32: 908-914
    CrossrefPubMedSearch in Google Scholar
  • 27 Hashimoto R, Hirasawa D. Duodenal endoscopic submucosal dissection with traction method using the S-O clip. Dig Endosc 2017; 29: 635
    CrossrefPubMedSearch in Google Scholar
  • 28 Ritsuno H, Sakamoto N, Osada T. et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg Endosc 2014; 28: 3143-3149
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 30 Tanaka S, Saitoh Y, Matsuda T. et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol 2015; 50: 252-260
    CrossrefPubMedSearch in Google Scholar
  • 31 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
    CrossrefPubMedSearch in Google Scholar
  • 32 Matsumoto A, Tanaka S, Oba S. et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010; 45: 1329-1337
    CrossrefPubMedSearch in Google Scholar
  • 33 Tajiri H, Kitano S. Complications associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental. Dig Endosc 2004; 16: S134-S136
    CrossrefPubMedSearch in Google Scholar
  • 34 Osada T, Sakamoto N, Shibuya T. et al. “Loops-attached rubber band” facilitation of endoscopic submucosal dissection of superficial colorectal neoplasm. Endoscopy 2008; 40: E101-E102
    Thieme ConnectPubMedSearch in Google Scholar
  • 35 Tomiki Y, Ishiyama S, Sugimoto K. et al. Colorectal endoscopic submucosal dissection by using latex-band traction. Endoscopy 2011; 43: E250-E251
    Thieme ConnectPubMedSearch in Google Scholar