Dual-functional use of thread delivery hood for traction-assisted rectal endoscopic submucosal dissection and defect closure

Endoscopic closure of an artificial defect after colorectal endoscopic submucosal dissection (ESD) is useful in preventing adverse events [1], with several closure methods having been developed [2] [3]. While the use of traction facilitates ESD [4], no devices currently exist that can facilitate both traction and closure. An elastic thread delivery hood (Dual Traction Hood; Adachi Co., Ltd., Osaka, Japan and Nomura Medical Device Co., Ltd., Nagano, Japan) that has dual threads with multi-rings inside the cap has been developed for traction use ([Fig. 1]) [5]. We describe a case in which this device was used successfully for traction as well as closure in a rectal ESD ([Video 1]).

Fig. 1 Dual Traction Hood, which has dual threads with multi-rings inside the cap.

Video 1 A Dual Traction Hood was used successfully for traction as well as closure in a rectal endoscopic submucosal dissection.

A 65-year-old man presented with a rectal neuroendocrine tumor ([Fig. 2]). Rectal ESD was performed using a Dual Traction Hood as follows. The first thread was used for the traction. After a submucosal pocket was created followed by a whole circumferential incision, the thread was released from the hood using a hemoclip (HX-610-090; Olympus, Tokyo, Japan). Using hemoclips, the thread was then fixed to the edge of the pocket and the opposite normal mucosa ([Fig. 3]). Traction-assisted ESD was completed successfully, leaving an artificial defect 30 mm wide ([Fig. 4]).

Fig. 2 Rectal endoscopic submucosal dissection was performed on a neuroendocrine tumor 8 mm in diameter.

Fig. 3 Traction facilitated rectal endoscopic submucosal dissection after the thread was fixed to the edge of the pocket and opposite the normal mucosa using hemoclips.

Fig. 4 An artificial defect 30 mm in diameter after endoscopic submucosal dissection.

The second thread was used to close the defect post-ESD. One ring of the thread was anchored to the defect edge using a hemoclip, and another ring was anchored to the opposite edge. The procedure was repeated in a zig-zag pattern while the thread was attached to both edges. Consequently, the defect was approximated by these hemoclips. Complete closure was achieved with additional hemoclips ([Fig. 5]). The ESD and closure took 20 and 15 minutes, respectively.

Fig. 5 a–c One ring of the thread was anchored to the defect edge using a hemoclip, and another ring was anchored to the opposite edge. The defect was approximated by these hemoclips. The thread was then anchored to both edges in a zig-zag pattern. d Complete closure was achieved using additional hemoclips.

The Dual Traction Hood enabled clinicians to achieve both traction-assisted ESD and endoscopic defect closure. This method may become an effective option in facilitating ESD and preventing delayed complications.

Endoscopy_UCTN_Code_TTT_1AQ

• References

• 1 Ogiyama H, Tsutsui S, Murayama Y. et al. Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection. Endosc Int Open 2018; 6: E582-E588
• 2 Abe S, Saito Y, Tanaka Y. et al. A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study. Endoscopy 2020; 52: 780-785
• 3 Kato M, Takeuchi Y, Yamasaki Y. et al. Technical feasibility of line-assisted complete closure technique for large mucosal defects after colorectal endoscopic submucosal dissection. Endosc Int Open 2017; 5: E11-E16
• 4 Saito Y, Parra-Blanco A. Traction is most important for the widespread use of endoscopic submucosal dissection, especially in procedures presenting particular difficulty. Endoscopy 2020; 52: 328-329
• 5 Fujita K, Takeshita M, Moriyama E. et al. Novel technique for endoscopic submucosal dissection using an elastic thread delivery hood. Endoscopy 2020; 52: E178-E180