DOUBLE ENDOSCOPE ASSISTED ENDOSCOPIC SUBMUCOSAL DISSECTION FOR TREATING TUMORS IN RECTUM AND DISTAL COLON: A FEASIBILITY STUDY

Aims Colorectal Endoscopic submucosal dissection (ESD) is an effective but challenging procedure. To facilitate its performance, several methods that apply traction are available; however, the optimal one remains to be established. Aim of this study was to evaluate the feasibility and safety of the double-endoscope assisted ESD (DEA-ESD) by improving traction to treat complex colorectal lesions.

Methods Naïve or previously treated lesions in rectum and sigmoid colon were included. A grasping forceps advanced through a small-caliber endoscope (GIF-XP190 N, Olympus Medical Systems, Tokyo, Japan, 5.4 mm outer diameter) was used to apply traction to the mucosal flap. Lesions were deemed complex when they exceeded a total of 9 points of the SMSA scoring system (size, morphology, site, and access) and recurrent when they were previously treated by Endoscopic Mucosal Resection (EMR). Outcome measures included procedural success rate, total procedure time, R0-resection rate, complications rate and recurrence rate at 3 months follow up.

Results 9 patients, mean aged 62.3 ± 14.5 years were included; five had rectal and four had tumours in the sigmoid colon. Median SMSA score was 14 (SMSA Level IV – complex polyp) while 3 patients were pre-treated with EMR. DEA-ESD was technically feasible in all cases. En bloc resection and R0 resection rates were 100%, respectively with a mean procedure time of 128.4 minutes. No immediate or delayed complications occurred.

Conclusions DEA-ESD is a feasible and safe method for treating complex or recurrent tumors in the rectum and distal colon.

*Georgios Tziatzios is a scholar of the Hellenic Society of Gastroenterology (H.S.G.)