CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(09): E1166-E1174
DOI: 10.1055/a-0965-8531
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

Jérémie Jacques
1  Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
2  Bio-Em, Xlim CNRS UMR 7252 Limoges, France
,
Aurélie Charissoux
3  Pathology Division, Dupuytren University Hospital, Limoges, France
,
Pierre Bordillon
1  Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
Romain Legros
1  Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
Jérôme Rivory
4  Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, Hospices Civils de Lyon, France
,
Valérie Hervieu
5  Pathology Division, East Hospital Group, Hospices Civils de Lyon, France
,
Jérémie Albouys
1  Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
Anne Guyot
3  Pathology Division, Dupuytren University Hospital, Limoges, France
,
Thierry Ponchon
4  Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, Hospices Civils de Lyon, France
6  Inserm U1032, Labtau, Lyon, France
,
Denis Sautereau
1  Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
Sebastien Kerever
7  Statistic Department, Lariboisière Hospital, APHP, Paris France
,
Mathieu Pioche
4  Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, Hospices Civils de Lyon, France
6  Inserm U1032, Labtau, Lyon, France
› Author Affiliations
Further Information

Publication History

submitted 05 December 2018

accepted after revision 22 May 2019

Publication Date:
29 August 2019 (online)

Abstract

Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band.

Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017.

Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).

At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators.

Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.