Clinical usefulness of a single-use splinting tube for poor endoscope operability in deep colonic endoscopic submucosal dissection

Background and study aims: Poor endoscope operability remains a significant challenge during colorectal endoscopic submucosal dissection (ESD). We retrospectively evaluated the experience and clinical usefulness of a new single-use splinting tube in deep colonic ESD in the setting of poor scope operability.

Patients and methods: Among 691 patients with colorectal tumors treated with ESD at Hiroshima University Hospital between November 2009 and July 2015, we analyzed 20 consecutive patients who underwent deep colonic ESD using a single-use splinting tube because of poor scope operability. Poor operability was defined as paradoxical movement of the endoscope, poor control with adhesions, and lesion motion with heartbeat or breathing. Technical and clinical success rates and adverse events were assessed.

Results: Paradoxical movement and poor control with adhesions were improved in all cases using the single-use splinting tube. The en bloc resection rate was 95 % (19/20) and histological en bloc resection rate was 100 % (20/20). There were no complications related to use of the splinting tube.

Conclusions: Use of a single-use splinting tube helped to overcome poor scope operability in deep colonic 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 Tanaka S, Terasaki M, Hayashi N et al. Warning for unprincipled colorectal ESD: accurate diagnosis and reasonable treatment strategy. Dig Endosc 2013; 23: 107-116
• 3 Tanaka S, Saitoh Y, Matsuda T et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol 2015; 50: 252-260
• 4 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
• 5 Nakajima T, Saito Y, Tanaka S et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 2013; 27: 3262-3270
• 6 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
• 7 Yoshida N, Wakabayashi N, Kanemasa K et al. Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 2009; 41: 758-761
• 8 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
• 9 Hawari R, Pasricha PJ. Going for the loop: a unique overtube for the difficult colonoscopy. J Clin Gastroenterol 2007; 41: 138-140
• 10 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
• 11 Matsumoto A, Tanaka S, Oba S et al. Outcome of endoscopic submucosal dissec- tion for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 2010; 45: 1329-1337
• 12 Pasha SF, Harrison ME, Das A et al. Utility of double-balloon colonoscopy for completion of colon examination after incomplete colonoscopy with conventional colonoscope. Gastrointest Endosc 2007; 65: 848-853
• 13 Teshima CW, Aktas H, Haringsma J et al. Single-balloon-assisted colonoscopy in patients with previously failed colonoscopy. Gastrointest Endosc 2010; 71: 1319-1323
• 14 Keswani RN. Single-balloon colonoscopy versus repeat standard colonoscopy for previous incomplete colonoscopy: a randomized, controlled trial. Gastrointest Endosc 2011; 73: 507-512
• 15 Ohya T, Ohata K, Sumiyama K et al. Balloon overtube- guided colorectal endoscopic submucosal dissection. World J Gastroenterol 2009; 15: 6086-6090