Colorectal submucosal dissection using a novel traction method with a threaded clip attached to the outside of the lesion

Colorectal endoscopic submucosal dissection (ESD) continues to present technical challenges. However, several reports indicate that traction devices can effectively reduce procedure times and complications associated with colorectal ESD [1] [2].

We developed a novel traction technique using a threaded clip attached to the outside of the lesion for lesions present in the greater curvature of the gastric body face-on to the scope [3]; we termed this the “outside-the-lesion clip–thread method” (O-CTM). The advantage of this technique is that traction by the thread changes the angle of the lesion, making it align parallel with the scope rather than face-on to it, thus allowing ESD to be performed safely. In the case reported here, we applied this technique to a colorectal neoplasm in the cecum.

A 75-year-old man presented with a 30-mm 0-IIa lesion in the cecum ([Fig. 1]) and underwent ESD ([Video 1]). The lesion faced directly at the scope and thus was difficult to incise. For this reason, we decided to perform ESD using O-CTM with a balloon overtube (ST-CB1; Olympus Corporation).

Fig. 1 A 30-mm 0-IIa lesion in the cecum, face-on to the scope.

Colorectal endoscopic submucosal dissection using the outside-the-lesion clip–thread method enabled safe dissection of a colorectal adenoma in cecum.Video 1

Initially, a full circumferential incision was made. After that, the mucosa outside the full circumferential incision was grasped with grasping forceps and pulled to confirm the actual field of view, and the scope was pulled out from the balloon overtube that had already been inserted. A clip with a thread was attached to the scope, which was then reinserted. This clip was then attached to a pre-identified point, and traction on the thread changed the angle of the lesion, bringing it parallel to the scope ([Fig. 2]). The submucosal dissection could then be performed safely, and en bloc resection was possible without complication. Pathological analysis revealed that the lesion was a severe adenoma with a negative margin ([Fig. 3]).

Fig. 2 The face-on lesion was brought parallel to the scope by means of traction on the thread.

Fig. 3 Histopathological section of the lesion showing an adenoma with negative margins.

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Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Matsui H, Tamai N, Futakuchi T. et al. Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience. BMC Gastroenterol 2022; 22: 10
• 2 Rituno H, Sakamoto N, Osada T. et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg Endosc 2014; 28: 3143-3149
• 3 Yamada K, Tajika M, Tanaka T. et al. A novel method of endoscopic submucosal dissection using a threaded clip for a lesion of the greater curvature of the gastric body. Endoscopy 2023; 55: E623-E624

Publication History

Article published online:
07 February 2024