Download PDF
Endoscopy 2001; 33(3): 253-256
DOI: 10.1055/s-2001-12810
Short Communication
© Georg Thieme Verlag Stuttgart · New York

A Novel Approach to Endoscopic Colorectal Mucosal Resection Using a Three-Channel Outer Tube and Multiple Forceps: An Experimental Assessment

M. Mukai1 , H. lwase1 , S. Himeno1 , M. Ishii1 , S. Yasuda1 , H. Nakazaki1 , H. Makuuchi2
  • 1 Dept. of Surgery, Tokai University Oiso Hospital, Kanagawa, Japan
  • 2 Dept. of Surgery, Tokai University School of Medicine, Kanagawa, Japan
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Also available at
    Permissions and Reprints

Background and Study Aims: Colorectal endoscopic mucosal resection (EMR) has limitations both anatomically and technically when it is done using the conventional snare wire method. The aim of this study was to develop a new method and instrument for colorectal EMR.

Methods: A total of 21 EMR procedures were done using ten surgical specimens. Saline was injected into the normal submucosa of freshly resected colorectal specimens to prepare a pseudotumor. EMR was performed experimentally by employing a three-channel outer tube with three forceps and a colonoscope with a needle-type precutting knife. This method was assessed in terms of safety and the size of the resected specimens.

Results: Perforation occurred only twice in the initial stage of this study. The size of the specimens resected by EMR was 28 - 39 mm (long diameter 34.8 ± 3.11), by 22 - 28 mm (short diameter 25.8 ± 2.07).

Conclusion: This method can achieve safety and en bloc mucosal resection to the submucosal layer. This novel approach may be promising for clinical application as a new form of endoscopic surgery.

References

  • 1 Makuuchi H, Machimura T, Sugihara T, et al. Endoscopic diagnosis and treatment of mucosal carcinoma of the esophagus (in Japanese with English abstract).  Endosc Dig. 1990;  2 447-452
    PubMedGoogle Scholar
  • 2 Inoue H, Endo M. Endoscopic esophageal mucosal resection using a transparent tube.  Surg Endosc. 1990;  4 189-201
    PubMedGoogle Scholar
  • 3 Makuuchi H, Machimura T, Soh Y, et al. Endoscopic mucosectomy for mucosal carcinomas in the esophagus (in Japanese with English abstract).  Jpn J Surg Gastroenterol. 1991;  24 2599-2603
    PubMedGoogle Scholar
  • 4 Makuuchi H. Endoscopic mucosal resection for early esophageal cancer; indications and techniques (editorial).  Dig Endosc. 1996;  8 175-179
    PubMedGoogle Scholar
  • 5 Deyhle P, Largiadèr F, Jenny S, Fumagalli I. A method for endoscopic electroresection of sessile colonic polyps.  Endoscopy. 1973;  5 38-40
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Kudo S. Endoscopic mucosal resection of flat and depressed type of early colorectal cancer.  Endoscopy. 1993;  7 455-461
    PubMedGoogle Scholar
  • 7 Waye J D. Techniques of polypectomy: hot biopsy forceps and snare polypectomy.  Am J Gastroenterol. 1987;  82 615-618
    PubMedGoogle Scholar
  • 8 Walsh R M, Ackroyd F W, Shellito P C. Endoscopic resection of large sessile colorectal polyps.  Gastrointest Endosc. 1992;  38 303-309
    CrossrefPubMedGoogle Scholar
  • 9 Binmoeller K F, Bohnacker S B, Seifert H, Thonke F, Valdeyar H, Soehendra N. Endoscopic snare excision of “giant” colorectal polyps.  Gastrointest Endosc. 1996;  43 83 -88
    PubMedGoogle Scholar
  • 10 Kanamori T, Itoh M, Yokoyama Y, Tsuchida K. Injection-incision-assisted snare resection of large sessile colorectal polyps.  Gastrointest Endosc. 1996;  43 189-195
    CrossrefPubMedGoogle Scholar
  • 11 Inoue M, Shiozaki H, Tamura S, Monden M. Endoscopic mucosal resection for early esophageal cancer (in Japanese with English abstract).  Jpn J Clin Med (Nippon Rinsho). 1996;  54 1286-1291
    PubMedGoogle Scholar
  • 12 Suzuki H, Masuda K, Fujisaki J, Okuwaki S. Endoscopic treatment of gastrointestinal cancers - indication and limitation (in Japanese with English abstract).  Jpn J Clin Med (Nippon Rinsho). 1996;  54 1699-1704
    PubMedGoogle Scholar
  • 13 Deyhle P. A plastic tube for the maintenance of the straightening of the sigmoid colon during colonoscopy.  Endoscopy. 1972;  4 224-226
    PubMedGoogle Scholar
  • 14 Makiishi H, Kitano K, Kobayashi K. A sliding tube method available for colonofiberscopy (in Japanese with English abstract).  Gastoenterol Endosc. 1972;  14 95-101
    PubMedGoogle Scholar
  • 15 Nakae Y, Nagasako K, Sasaki H, Aoki G, Takemoto T. Clinical experience with a long sliding tube for colonoscopy.  Endoscopy. 1975;  7 233-238
    PubMedGoogle Scholar
  • 16 Weinstock L B, Shatz B A. Endoscopic treatment of a colonic anastomotic mucosal bridge.  Gastrointest Endosc. 1994;  40 773-774
    PubMedGoogle Scholar
  • 17 Silverman W B. Simple method for making triple-lumen needle-knife papillotome (letter).  Gastrointest Endosc. 1996;  43 264
    PubMedGoogle Scholar
  • 18 Ramirez F C, Zierer S T, Mills M R, Sanowski R A. Endoscopic removal of an entrapped foreign body from the sigmoid colon using a needle knife.  Gastrointest Endosc. 1996;  44 84-85
    PubMedGoogle Scholar
  • 19 Sadahiro S, Ishida H, Tokunaga N, et al. Experimental assessment of endoscopic mucosectomy with a cap-fitted panendoscope.  Endoscopy. 1998;  30 713 -717
    PubMedGoogle Scholar
  • 20 Monson J RT, Hill A DK, Darzi A. Laparoscopic colonic surgery.  Br J Surg. 1995;  82 150-157
    PubMedGoogle Scholar
  • 21 Mukai M, Sadahiro S, Tokunaga N, et al. Clinical experiences with laparoscopic colectomy.  Dig Endosc. 1997;  9 11-15
    PubMedGoogle Scholar
  • 22 Buess G, Mentges B. Transanal endoscopic microsurgery (TEM).  Minim Invasive Ther. 1992;  1 101-109
    PubMedGoogle Scholar
  • 23 Buess G. Review: transanal endoscopic microsurgery (TEM).  J R Coll Surg Edinb. 1993;  38 239-245
    PubMedGoogle Scholar

M. Mukai, M.D.

Dept. of Surgery
Tokai University Oiso Hospital

Gakyou 21-1, Oiso
Kanagawa, 259-0198
Japan


Fax: Fax:+ 81-463-722256

      >