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Usefulness of step-by-step double-clip-with-line method in duodenal endoscopic submucosal dissection.

ABSTRACT:

SUBMITTER: Yoshida A

PROVIDER: S-EPMC8276354 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Mucosal defect closure after duodenal endoscopic submucosal dissection using the reopenable-clip over the line method.

Project description:IntroductionClosure of mucosal defects after duodenal endoscopic submucosal dissection (ESD) is important to prevent postoperative adverse events. Previously, we devised an underwater reopenable-clip closure method for effective closure of mucosal defects under endoscopic guidance within the field of view. Recently, the usefulness of a method using a clip with a line passing through an accessory channel to close a mucosal defect has been reported. We also described a reopenable-clip over the line method (ROLM) to completely close margin and the muscular layers of mucosal defects using a clip line.Case reportOur patient was a 70-year-old woman with a 40-mm duodenal tumor in the descending portion of the duodenum. The lesion was completely resected using ESD . In the result, the mucosal defect size was approximately 50 mm, representing about 3/4 of the duodenal circumference. A clip-line closure was performed using ROLM to close the mucosal defect's margins completely. An additional clip was applied to close the mucosal defect after ESD completely. Subsequently, the line was fixed with a modified locking-clip technique, closed, and cut with endoscopic scissors. The patient was discharged without any adverse events 9 days after the duodenal ESD.DiscussionMucosal defect closure after duodenal ESD using ROLM is a novel method that can reliably close mucosal defects.

| S-EPMC8264231 | biostudies-literature

Underwater reopenable clip closure of mucosal defects after duodenal endoscopic submucosal dissection.

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Successful removal of duodenal submucosal tumors with endoscopic submucosal dissection.

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Successful duodenal endoscopic submucosal dissection using multiple clip-and-thread traction for a large tumor located in the duodenal bulb.

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| S-EPMC8058531 | biostudies-literature

Traction-assisted colonic endoscopic submucosal dissection using clip and line: a feasibility study.

Project description:Colonic endoscopic submucosal dissection (ESD) is a challenging procedure because it is often difficult to maintain good visualization of the submucosal layer. To facilitate colonic ESD, we designed a novel traction method, namely traction-assisted colonic ESD using clip and line (TAC), and investigated its feasibility.We retrospectively analyzed 23 patients with large colonic superficial lesions who had undergone TAC. The main outcome was the procedural success rate of TAC, which we defined as successful, sustained application of clip and line to the lesion until the end of the procedure.The procedural success rate of TAC was 87 % (20/23). In all three unsuccessful cases, the lesions were in the proximal colon and the procedure times over 100 minutes. The overall mean procedure time was 61 min (95 % confidence interval, 18 - 172 min). We achieved en bloc resections of all lesions. There were no perforations or fatal adverse events.TAC is feasible and safe for colonic ESD and may improve the ease of performing this procedure.

| S-EPMC4713171 | biostudies-other

Usefulness and safety of a scissors-type knife in endoscopic submucosal dissection for nonampullary duodenal epithelial tumors.

Project description: Not available

| S-EPMC6119203 | biostudies-literature

Clip with line-pulley securing technique with plastic detachable snare for endoscopic submucosal dissection defect closure.

Project description:Video 1Clip with line-pulley securing technique with plastic detachable snare for endoscopic submucosal dissection defect closure.

| S-EPMC10928135 | biostudies-literature

Minimally invasive management of large duodenal lipoma: endoscopic submucosal dissection.

Project description:ObjectiveThis study was performed to compare the clinical outcomes of large duodenal lipomas (DLs) of ≥2 cm between endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFTR).MethodsThis retrospective study included patients who underwent endoscopic resection of large DLs from June 2017 to March 2021 at our hospital. Clinicopathologic features, clinical outcomes, and follow-up endoscopy findings were retrospectively reviewed.ResultsTwenty-three patients (12 men) with a mean age of 57.4 years were included. The median tumor size was 28.4 ± 13.3 mm. ESD was performed in 19 patients, and EFTR was performed in 4. Complete resection was achieved in 21 patients. The operative time and postoperative hospital stay were significantly shorter in the ESD than EFTR group. Four patients in the EFTR group developed a fever; no other adverse events occurred. No patients required surgical intervention. During the average follow-up of 21.1 months, no residual tumor, recurrence, or metastasis was observed.ConclusionBoth ESD and EFTR provide minimally invasive, localized treatment of selected DLs. ESD might have some advantages in resecting large DLs in terms of procedure time and hospitalization.

| S-EPMC8721732 | biostudies-literature

Double-tunneling butterfly method for endoscopic submucosal dissection of extensive rectal neoplasms.

Project description:Background and aims:Endoscopic submucosal dissection (ESD) is the preferred technique for en bloc resection of superficial colorectal neoplasms. Resection of extensive lesions with ESD can be challenging, owing to loss of orientation in the submucosal space. In this case series, we describe the double-tunneling (DoT) butterfly method for ESD of extensive rectal neoplasms. Methods:The key feature of the DoT butterfly method is the creation of 2 tunnels that are transformed into bilateral flaps, leaving a submucosal septum between them. Results:Four rectal neoplasms measuring (maximum diameter) 7 cm, 8 cm, 9 cm, and 18 cm, respectively, were resected in 4 patients by use of the DoT butterfly method. The lesions included recurrent adenoma (n = 1) and dysplasia (n = 1) in longstanding ulcerative colitis. Curative R0 resection was confirmed in all 4 cases. Histologic examination showed tubular adenomas with low-grade dysplasia in 1 of 4 patients and focal high-grade dysplasia in 3 of 4 patients. One patient experienced postprocedural bleeding that required endoscopic reintervention. Conclusion:The DoT butterfly method appears to be useful for the resection of extensive rectal neoplasms. A prospective study is required to assess whether these results can be reproduced in a large cohort of patients.

| S-EPMC7004922 | biostudies-literature

Internal traction method using a spring-and-loop with clip (S-O clip) allows countertraction in gastric endoscopic submucosal dissection.

Project description:BackgroundInsufficient countertraction and poor field of vision make endoscopic submucosal dissection (ESD) difficult. Internal traction method using a spring-and-loop with clip (SLC) allows sufficient traction in any direction and good field of vision. However, the attachment procedure is difficult and interference with the endoscope can occur in the retroflexed endoscopic position. We have developed a new use of SLC that simplifies the attachment procedure, eliminating interference with the endoscope. The aim of this study was to investigate the efficacy of SLC for gastric ESD.MethodsWe retrospectively recruited 140 patients with gastric neoplasms who underwent ESD between November 2015 and October 2018 at our department. Among them, 51 patients treated using SLC-assisted ESD (SLC-ESD) and 89 patients treated using conventional ESD (C-ESD) were compared. Propensity score matching was performed to compensate for the differences in age, sex, lesion location, lesion position, specimen size, and ulcer findings. The primary outcome was ESD procedure time.ResultsPropensity score matching generated 51 matched pairs. The procedure time in the SLC-ESD group was significantly shorter than that in the C-ESD group (median [interquartile], 40.0 [27.0-81.5] minutes versus 69.0 [46.5-113.5] minutes, P = 0.008). The mean SLC attachment time was 2.08 min. There were no significant differences in complete en bloc resection rate between SLC-ESD and C-ESD groups (100% versus 96.1%, P = 0.495). There were not perforation cases in either group.ConclusionsSLC may offer an efficient method for gastric ESD, with a short attachment procedure time.

| S-EPMC7326859 | biostudies-literature

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