Effectiveness of counter traction using a clip with a looped thread for colorectal endoscopic submucosal dissection

Introduction

Colorectal cancer is the third most common type of cancer and the second most common cause of cancer-related mortality in the world [1]. Endoscopic resection of adenomatous polyps is reported to reduce the incidence of colorectal cancer [2]. However, polyps that are large and those that are removed piecemeal are risk factors for residual neoplasia [3]. Therefore, colorectal endoscopic submucosal dissection (ESD) has been found to have a high en bloc resection rate compared with endoscopic mucosal resection (EMR) [4]. In recent years, colorectal ESD has become a common endoscopic procedure. However, in Western countries, colorectal ESD is not the standard treatment for large colorectal lesions [5] [6] because the procedure is challenging and the rate of perforation is higher than that for EMR [7]. These challenges are attributable to the fact that the colorectal wall is thin and the maneuvering ability of the endoscope in the colon is limited. In addition, several factors pertaining to technical difficulties have been reported [8] [9]. To ensure smooth and safe performance of colorectal ESD, it is important to maintain appropriate visibility of the submucosal layer in an easy and quick manner. Therefore, we developed a treatment strategy for colorectal ESD using a clip with a looped thread (LT) [10]. This traction method is cost-effective as well as easy to perform compared with previously reported methods. The present study was designed to evaluate the safety and effectiveness of this novel traction method.

Publication History

Received: 02 June 2020

Accepted: 11 November 2020

Article published online:
18 February 2021

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