Endoscopic submucosal dissection (ESD) allows curative en-bloc resection of early GI neoplasms. Conventional ESD for colonic tumors using knives is technically demanding with high perforation risks because of difficulty in controlling the depth of dissection and thin colonic wall. Moreover, lack of traction can make the procedure very time consuming, especially for large polyps. Clutch Cutter (Fujiflim, Japan) is a rotatable, grasping-type scissor forceps that can grasp and cut a piece of tissue precisely with an electrosurgical current. Traction using a hemoclip attached to dental floss allows good exposure of the submucosal plane to enhance dissection. In a patient with an 8 × 5-cm sigmoid lateral spreading tumor, granular type (Paris Is+IIa, Sano type II), we combined the use of a Clutch Cutter for mucosal incision and submucosal dissection and a hemoclip (HX610-135; Olympus, Japan) attached to dental floss as a traction method to facilitate the progress of ESD (Fig. 1, Video 1, available online at www.giejournal.org). The time required to complete the procedure was 314 minutes (7.85 min/cm2), which is significantly shorter compared with ESD with conventional knives without any traction method in our center (39.2 min/cm2).
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Published online: April 07, 2016Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy