New closure technique for large mucosal defects after endoscopic submucosal dissection of colorectal tumors (with video) - 15/02/12
Reprint requests: Yutaka Saito, MD, PhD, Chief Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, JapanRésumé |
Background |
Certain large colorectal tumors satisfy expanded indications for endoscopic submucosal dissection (ESD); however, the resulting large mucosal defects may contribute to complications such as delayed bleeding and perforation. Various closure devices and methods have been developed for large mucosal defects to prevent such complications.
Objective |
To demonstrate the feasibility of a new and simple technique for closing large mucosal defects after colorectal ESD.
Design |
Pilot feasibility study.
Setting |
Single center.
Patients |
Ten patients with 10 tumors half circumferential or less in size with sufficient muscle layer exposure after ESD were selected and treated by using the closure technique between July 2009 and June 2010.
Intervention |
Small mucosal incisions were made around the mucosal defect by the same needle-knife used during ESD. These incisions provided a better grip for conventional clips, which then facilitated lifting the surrounding mucosa across the defect without slipping, thereby making it considerably easier to reduce the size of the defect and place additional clips.
Main Outcome Measurements |
Patient characteristics and tumor clinicopathologic features were assessed as well as closure completion rate, closure procedure time, and closure-related complications.
Results |
All 10 tumors were successfully treated by ESD. Mean lesion size was 26.8 mm (range 8-50 mm). All mucosal defects were completely closed by using the new closure technique, without complications. Mean closure procedure time was 15 minutes (range 8-35 minutes).
Limitations |
Small sample size with specifically selected patients.
Conclusion |
Large mucosal defects resulting from colorectal ESD can be completely closed with small mucosal incisions by using conventional clips.
Le texte complet de cet article est disponible en PDF.Abbreviations : ESD, LST
Plan
| DISCLOSURE: Y. Saito received funding support from the Japanese Foundation for Research and Promotion of Endoscopy. No other financial relationships relevant to this publication were disclosed. |
|
| If you would like to chat with an author of this article, you may contact Dr Saito at ytsaito@ncc.go.jp. |
Vol 75 - N° 3
P. 663-667 - mars 2012 Retour au numéro
Article précédent
- Role of self-expandable stents for patients with colon cancer (with videos)
- Todd H. Baron, Louis M. Wong Kee Song, Alessandro Repici
- Glass dust esophagitis: an unusual cause of chest pain
- Hye Sun Park, Dong Soo Han, Joong Ho Bae, Yil Sik Hyun, Chang Soo Eun, Young-Ha Oh
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?