Usefulness of underwater endoscopic submucosal dissection in saline solution with a monopolar knife for colorectal tumors (with videos)

  • Mitsuru Nagata
    Reprint requests: Mitsuru Nagata, MD, Shonan Fujisawa Tokushukai Hospital 1-5-1 Tujidoukandai Fujisawa-Shi Kanagawa 251-0041, Japan.
    Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, Kanagawa, Japan
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Published:December 11, 2017DOI:

      Background and Aims

      Generally, colorectal endoscopic submucosal dissection (ESD) is performed with a monopolar knife with CO2 supply from an endoscope. There are few case reports about underwater ESD (UESD) in saline solution with a bipolar knife. The usefulness and safety of UESD in saline solution with a monopolar knife are unclear. The present study aimed to investigate the usefulness and safety of UESD in saline solution with a monopolar knife for colorectal tumors.


      This retrospective, observational study on UESD for colorectal tumors included 26 colorectal tumors from 24 patients treated with UESD at our department between October 2015 and February 2017. The characteristics of patients, factors associated with ESD difficulty, treatment results, and variations in blood test data before and after UESD were analyzed.


      En bloc resection was successful in all lesions without any serious adverse events. The median major diameter of the resected specimens was 30 mm (interquartile range [IQR], 28-35) and of the tumor 22.5 mm (IQR, 17.8-25.3). The median procedure time was 60 minutes (IQR, 45-111) and median speed of dissection 10.4 mm2/min (IQR, 6.4-12.2). No cases of perforation occurred. Post-ESD bleeding occurred in only 1 case, and endoscopic hemostasis was achieved. There was no case of electrolyte imbalance requiring treatment after UESD.


      UESD in saline solution with a monopolar knife for colorectal tumors is useful and safe. UESD has potential advantages that should be further assessed.

      Graphical abstract


      CESD (conventional endoscopic submucosal dissection), CRP (C-reactive protein), ESD (endoscopic submucosal dissection), IQR (interquartile range), UESD (underwater endoscopic submucosal dissection), WBC (white blood cell)
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