Endoscopy 2018; 50(08): 800-808
DOI: 10.1055/s-0044-100720
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Balloon-assisted endoscopy facilitates endoscopic submucosal dissection of difficult superficial proximal colon tumors

Takeshi Yamashina
1  Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
2  Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
,
Yoshikazu Hayashi
1  Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Hirotsugu Sakamoto
1  Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Tomonori Yano
1  Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Yoshimasa Miura
1  Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Satoshi Shinozaki
1  Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
3  Shinozaki Medical Clinic, Utsunomiya, Japan
,
Keijiro Sunada
1  Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
,
Alan Kawarai Lefor
4  Department of Surgery, Jichi Medical University, Shimotsuke, Japan
,
Hironori Yamamoto
1  Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
› Author Affiliations
Further Information

Publication History

submitted 04 July 2017

accepted after revision 16 December 2017

Publication Date:
12 February 2018 (eFirst)

Abstract

Background Colorectal endoscopic submucosal dissection (ESD) can be technically difficult in some situations, such as paradoxical movement of the proximal colon. The double-balloon endoscope provides stable endoscopic maneuvering, even in the small intestine. The aim of this study was to assess the outcomes of balloon-assisted endoscopic submucosal dissection (BAESD) of colonoscopically difficult superficial proximal colon tumors.

Methods We retrospectively reviewed the records of patients who underwent BAESD of superficial proximal colon tumors where colonoscopic difficulties were encountered, from January 2011 to September 2016. Difficulties were defined as a previous incomplete colonoscopy using a conventional colonoscope or unstable endoscopic maneuverability around the tumor with a conventional colonoscope. A propensity score model was used as a secondary analysis to compare outcomes of the BAESD group with those of a non-BAESD group. 

Results BAESD was performed on 63 tumors in 63 patients. En bloc resection was achieved for 62 tumors (98 %) and an R0 resection was achieved for 55 tumors (87 %). Propensity score matching analysis created 59 matched pairs from the BAESD and non-BAESD groups. There were no statistically significant differences between the two groups in en bloc resection (100 % vs. 100 %; P > 0.99), R0 resection (90 % vs. 93 %; P = 0.74), perforation (0 % vs. 2 %; P > 0.99) or postoperative bleeding (3 % vs. 0 %; P = 0.50).

Conclusion Balloon-assisted endoscopy achieved safe and reliable ESD of colonoscopically difficult superficial proximal colon tumors.