New method
Clinical endoscopy
Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction (with video)

https://doi.org/10.1016/j.gie.2008.12.245Get rights and content

Background

Endoscopic submucosal dissection (ESD) allows en bloc resection of large GI neoplasms, regardless of their size; however, technical difficulties associated with ESD in the colorectum make it less widely applied in the treatment of tumors in this region. To address this difficulty, we designed a rubber strip-based traction device, called the S-O clip (Sakamoto-Osada clip) and reported previously that ESD with this device was effective for complete resection of large, superficial colorectal neoplasms. In this report, we describe a novel spring-action version of the S-O clip (spring S-O clip) that improves the facility of clip use during ESD of colorectal tumors.

Objective

To evaluate the efficacy and safety of the spring S-O clip for ESD of colorectal neoplasms.

Design

Case series.

Setting

Juntendo University Hospital.

Main Outcome Measurements

The efficacy and safety of the spring S-O clip traction device during ESD of colorectal tumors.

Results

In 3 cases, a large, superficial neoplasm in the right side of the colon was removed safely and successfully en bloc without complication. Procedure times for the 3 cases were 44, 27, and 49 minutes, with resected specimens measuring 40, 24, and 35 mm, respectively.

Limitation

Uncontrolled study.

Conclusion

This limited case series demonstrates that spring S-O clip-assisted ESD is safe and effective for en bloc resection of large superficial neoplasms in the right side of the colon.

Section snippets

Design of the spring S-O clip

The spring S-O clip consists of a metal clip attached to the end of a 7-mm long and 1.8-mm wide spring, which is connected at its other end to a double nylon loop (Fig. 1). The spring S-O clip can be passed through an endoscope instrument channel (Fig. 2). The length of the spring, which is not altered by a 1g force, extends approximately 10-fold at 20g.

S-O clip procedure

A conventional endoscope with a single instrument channel (PCF -Q240I; Olympus Optical Co. Ltd., Tokyo, Japan) was used for ESD. A

Results

All 3 spring S-O clip-assisted ESDs were performed safely; lesions were resected en bloc successfully and without complications. Fitting the spring S-O clip to each lesion was easy and required an average of only 2 minutes. Total procedure times were 44, 27, and 49 minutes for Patients 1, 2, and 3, respectively. Although circumferential cutting of normal tissues required 22, 14, and 24 minutes, respectively, the submucosal dissection time for each patient was approximately 20 minutes.

Discussion

The small angulated lumen and thinner wall in the colorectum increases the risk of complications with colorectal ESD relative to gastric ESD. For this reason, it is important to improve visualization of the cutting line in the submucosal layer. The spring S-O clip permits direct submucosal layer visualization and facilitates en bloc resection of large superficial colorectal tumors.

Various traction devices and techniques have been applied previously to facilitate ESD, including percutaneous

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    • DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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    Copyright © 2009 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.