Endoscopy 2018; 50(04): S65
DOI: 10.1055/s-0038-1637220
ESGE Days 2018 oral presentations
20.04.2018 – Colon: endoscopic resection session 1
Georg Thieme Verlag KG Stuttgart · New York

COLONIC ESD WITH SIMILAR RESULTS TO JAPANESE TEAMS IS POSSIBLE IN EUROPE USING THE DOUBLE-CLIP COUNTER-TRACTION STRATEGY

J Jacques
1   Limoges University Hospital, Limoges, France
,
R Legros
1   Limoges University Hospital, Limoges, France
,
J Rivory
2   Lyon Edouard Herriot Hospital, Lyon, France
,
T Ponchon
2   Lyon Edouard Herriot Hospital, Lyon, France
,
D Sautereau
1   Limoges University Hospital, Limoges, France
,
M Pioche
2   Lyon Edouard Herriot Hospital, Lyon, France
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

Colonic ESD is the most technically challenging location for large superficial precancerous and cancerous lesion. Appropriate exposure of the submucosal space could be very difficult even for Japanese experts due to its thinness in this location, inconstant help by the gravity, colonic loops, bowel and respiratory movements.

A lot of different strategies have been published to overcome this challenging issue in colon like pocket ESD or clip-with line technique. We recently report our strategy of double clip counter-traction using a rubber band.

Methods:

From September 2015 to September 2017, all cases of colonic ESD (rectal location excluded) were prospectively included in a bicentric database. Since March 2017 all Colonic ESD cases were performed using the previously published double clip counter-traction strategy.

A retrospective comparison between standard and double clip strategy was performed.

Results:

From September 2015 to September 2017, 132 colonic ESDs were performed in two experts centers (46% in distal colon and 54% in proximal colon). Mean age was 66 years old, mean specimen size was 53 × 41 mm, mean duration of procedure was 116 min and mean speed was 20,5 mm2/min. Cancer was found in pathological analysis in 43% of patients (32,5%). The Monobloc, R0 and curative resection rate were respectively 86,3%, 73,8% and 66,7%. 11 (8,2%) per procedural perforation occurred with only 1 requiring surgical intervention.

The double clip traction strategy significantly improves all endpoints: En bloc resection 96% vs. 81% (p = 0,016),, R0 resection 84,8% vs. 68,3% (p = 0,016),, curative resection: 82,6% vs. 58,5% (p = 0,024), speed of resection 28,1 vs. 15,7 mm2/min (p = 0,002), per procedural perforation: 0% vs. 13,2% (p = 0,003).

Conclusions:

Double clip counter-traction strategy allows high en bloc and R0 resection rate in colonic ESD with results similar to best Japanese teams. This strategy could become the standard strategy for colonic ESD.