EFFICACY OF THE DOUBLE CLIP COUNTERTRACTION METHOD FOR RESIDUAL OR LOCALLY RECURRENT LESIONS IN COLONIC ENDOSCOPIC SUBMUCOSAL DISSECTION

Aims:

Endoscopic submucosal dissection (ESD) for the resection of scarred colonic lesions is a feasible but challenging technique because of submucosal fibrosis. We previously reported an internal traction method using two clips and a rubber band and making ESD easier.

This study aimed to evaluate the efficacy and security of ESD using this countertraction technique in case of residual or locally recurrent colonic lesions.

Methods:

We retrospectively analyzed all residual or locally recurrent colonic lesions, DSM treated, in two french expert center, between august 2017 and October 2018. The countertraction technique has been systematically used.

The primary endpoint was the curative resection rate. Secondary endpoints were technical success rate, degrees of fibrosis, tumor diameter, procedure time, resection speed, secondary chirurgical treatment, and complication rate.

Results:

Among the 29 patients included, there were 18 (72%) locally recurrent colonic lesions and 11 (44%) residual lesions after a primary endoscopic resection. Severe submucosal fibrosis was observed in 25 patients (86%) and intermediate fibrosis in 4 patients (14%).

Mean resected tumor diameter, procedure time and resection speed were 41 mm [25 – 70 mm], 57 min [13 – 230 min], and 22mm2/min [6 – 60mm2/min], respectively. The successful resection rate was 90% (3 piecemeal mucosal resection conversion at the beginning of the study). This rate increased to 100% for the last twenty lesions because of the progression curve. The en bloc resection rate was 83%, but only 68% had negative margins (R0) mostly because of damaged lesions during the dissection. Only one patient has needed secondary surgical treatment but there was no residual neoplasm.

Complication included three (10%) small intraoperative perforations endoscopic treated. There was no secondary perforation or bleeding.

Conclusions:

In cases with scarred colonic lesions, ESD with double-clip counter traction allows curative resection with low complication risk. This technique is an alternative to Full thickness resection (FTRD) particularly for large lesions over 3 cm.