Advertisement

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

  • Mitsuru Nagata
    Correspondence
    Reprint requests: Mitsuru Nagata, MD, Shonan Fujisawa Tokushukai Hospital 1-5-1 Tujidoukandai Fujisawa-Shi Kanagawa 251-0041, Japan.
    Affiliations
    Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, Kanagawa, Japan
    Search for articles by this author
Published:December 11, 2017DOI:https://doi.org/10.1016/j.gie.2017.11.032

      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

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Gastrointestinal Endoscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Oda I.
        • Gotoda T.
        • Hamanaka H.
        • et al.
        Endoscopic submucosal dissection for early gastric cancer: technical feasibility, operation time and complication from a large consecutive series.
        Dig Endosc. 2005; 17: 54-58
        • Oyama T.
        • Tomori A.
        • Hotta K.
        • et al.
        Endoscopic submucosal dissection of early esophageal cancer.
        Clin Gastroenterol Hepatol. 2005; 3: S67-S70
        • Nakajima T.
        • Saito Y.
        • Tanaka S.
        • et al.
        Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan.
        Surg Endosc. 2013; 27: 3262-3270
        • Tanaka S.
        • Tamegai Y.
        • Tsuda S.
        • et al.
        Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan.
        Dig Endosc. 2010; 22: S2-S8
        • Binmoeller K.F.
        • Weilert F.
        • Shah J.
        • et al.
        “Underwater” EMR without submucosal injection for large sessile colorectal polyps (with video).
        Gastrointest Endosc. 2012; 75: 1086-1091
        • Yoshii S.
        • Hayashi Y.
        • Matsui T.
        • et al.
        “Underwater” endoscopic submucosal dissection: a novel technique for complete resection of a rectal neuroendocrine tumor.
        Endoscopy. 2016; 48: E67-E68
        • Akasaka T.
        • Takeuchi Y.
        • Uedo N.
        • et al.
        “Underwater” endoscopic submucosal dissection for superficial esophageal neoplasms.
        Gastrointest Endosc. 2017; 85: 251-252
        • Tanaka S.
        • Kashida H.
        • Saito Y.
        • et al.
        JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection.
        Dig Endosc. 2015; 27: 417-434
        • Cammarota G.
        • Cesaro P.
        • Cazzato A.
        • et al.
        The water immersion technique is easy to learn for routine use during EGD for duodenal villous evaluation: a single-center 2-year experience.
        J Clin Gastroenterol. 2009; 43: 244-248
        • Yahagi N.
        • Nishizawa T.
        • Sasaki M.
        • et al.
        Water pressure method for duodenal endoscopic submucosal dissection.
        Endoscopy. 2017; 49: E227-E228
        • Akasaka T.
        • Yusuke T.
        • Kenta H.
        • et al.
        Dive to the underwater world: a water immersion technique for endoscopic submucosal dissection of gastric neoplasms.
        Am J Gastroenterol. 2017; 112: 985
        • Takeuchi Y.
        • Iishi H.
        • Tanaka S.
        Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort.
        Int J Colorectal Dis. 2014; 29: 1275-1284
        • Imai K.
        • Hotta K.
        • Yamaguchi Y.
        Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training.
        Gastrointest Endosc. 2016; 83: 954-962
        • Ohya T.
        • Ohata K.
        • Sumiyama K.
        Balloon overtube-guided colorectal endoscopic submucosal dissection.
        World J Gastroenterol. 2009; 28: 6086-6090
        • Harada A.
        • Gotoda T.
        • Fukuzawa M.
        • et al.
        Clinical impact of endoscopic devices for colorectal endoscopic submucosal dissection.
        Digestion. 2013; 88: 72-78
        • Shiozawa H.
        • Aizawa T.
        • Ito T.
        • et al.
        A new transurethral resection system: operating in saline environment precludes obturator nerve reflexes.
        J Urol. 2002; 168: 2665-2667
        • Akintoye E.
        • Kumar N.
        • Aihara H.
        • et al.
        Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis.
        Endosc Int Open. 2016; 4: E1030-E1044
        • Inoue T.
        • Uedo N.
        • Yamashina T.
        • et al.
        Delayed perforation: a hazardous complication of endoscopic resection for non-ampullary duodenal neoplasm.
        Dig Endosc. 2014; 26: 220-227
        • Hiramatsu R.
        • Takeshita A.
        • Taguchi M.
        • et al.
        Symptomatic hyponatremia after voluntary excessive water ingestion in a patient without psychiatric problems.
        Endocr J. 2007; 54: 643-645
        • Gravenstein D.
        Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management.
        Anesth Analg. 1997; 84: 438-446
        • Morita A.
        • Yabushita K.
        • Kimura J.
        • et al.
        A case of stage IB gastric cancer caused peritoneal dissemination in 1 year after perforation during endoscopic submucosal dissection.
        Jpn J Gastroenterol Surg. 2007; 40: 399-404