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Evaluation of colorectal endoscopic submucosal dissection using a multifunctional snare: a prospective clinical feasibility study (with videos)

Published:September 17, 2020DOI:https://doi.org/10.1016/j.gie.2020.09.019

      Background and Aims

      The number of colorectal endoscopic submucosal dissections (ESDs) for early colorectal cancer is expected to increase in the future; therefore, cost reduction is a clinically important issue. The SOUTEN snare (Kaneka Medics, Tokyo, Japan) is a novel multifunctional snare developed for hybrid ESD at a low price. If ESD can be performed safely using the SOUTEN snare, the same therapeutic effect can be obtained as with conventional ESD at a lower cost. The aim of this prospective, pilot, clinical feasibility study was to evaluate the safety and efficacy of ESD using the SOUTEN snare (SOUTEN-ESD).

      Methods

      From October 2018 to January 2019, 119 consecutive patients (121 ESD procedures, 137 colorectal neoplasms) were prospectively enrolled and treated by SOUTEN-ESD at NTT Medical Center Tokyo and Omori Red Cross Hospital. The outcomes of SOUTEN-ESD were evaluated.

      Results

      Among 137 neoplasms, SOUTEN-ESD was completed in all cases. No cases required conversion to hybrid ESD or to a dedicated ESD device. The mean procedure time was 26.1 ± 14.3 minutes. Both the en-bloc resection rate and R0 resection rate were 100%. The rate of perforation was 0%, the rate of delayed bleeding was 2.2%, and the rate of post-ESD coagulation syndrome was 2.9%.

      Conclusions

      SOUTEN-ESD was safe and had good outcomes. Although further studies are required to examine indications for SOUTEN-ESD and confirm the results of this study, effective ESD with this novel knife is feasible. The SOUTEN snare is a realistic option for colorectal ESD. (Clinical trial registration number: UMIN 000034299.)

      Abbreviations:

      ESD (endoscopic submucosal dissection), SM (submucosal), PECS (post–endoscopic submucosal dissection coagulation syndrome), SOUTEN-ESD (endoscopic submucosal dissection using the SOUTON snare)
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      Linked Article

      • A knife plus a snare, but how will it fare?
        Gastrointestinal EndoscopyVol. 93Issue 3
        • Preview
          The introduction of EMR revolutionized the gastroenterologist’s ability to resect larger GI lesions, especially colonic polyps. However, lesions >20 mm in diameter cannot reliably be removed en bloc by EMR.1 This results in a piecemeal resection, which renders histopathologic margins unevaluable and is associated with higher rates of recurrence, warranting closer endoscopic surveillance and potentially additional therapy. Endoscopic submucosal dissection (ESD) is a technique pioneered in Japan that allows for en bloc resection, generally without the size limitations of EMR, and can spare the patient surgical resection if a superficially invasive cancer (with <1000-μm submucosal invasion) is detected and R0 resection is confirmed.
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