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.
Methods
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.
Results
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.
Conclusions
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
Graphical Abstract
Abbreviations:
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 11, 2017
Accepted:
November 24,
2017
Received:
July 17,
2017
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2018 by the American Society for Gastrointestinal Endoscopy
