Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 28, 2009; 15(48): 6086-6090
Published online Dec 28, 2009. doi: 10.3748/wjg.15.6086
Balloon overtube-guided colorectal endoscopic submucosal dissection
Tomohiko Ohya, Ken Ohata, Kazuki Sumiyama, Yousuke Tsuji, Ikuro Koba, Nobuyuki Matsuhashi, Hisao Tajiri
Tomohiko Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan
Ken Ohata, Yousuke Tsuji, Nobuyuki Matsuhashi, Division of Gastroenterology, Kanto Medical Center NTT EC, 5-9-22 Higashi-gotanda Shinagawa-ku, Tokyo 141-8625, Japan
Ikuro Koba, Division of Gastroenterology and Hepatology, Yamaga Chou Hospital, 1000 Yamagashi-yamaga, Kumamoto 861-0501, Japan
Hisao Tajiri, Department of Endoscopy, Department of Gastroenterology and Hepatology, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan
Author contributions: Ohya T and Ohata K performed the endoscopic procedures, were responsible for the conception and design of this study and wrote the manuscript; Sumiyama K, Tajiri H, Matsuhashi N and Koba I provided financial support, analysis and interpretation, critical revision of the article, and final approval of the article; Tsuji Y provided technical support and analysis in addition to interpretation of the data.
Supported by The Jikei University School of Medicine and Kanto Medical Center NTT EC
Correspondence to: Dr. Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shinbashi, Minato-ku, Tokyo 105-8461, Japan. kaz_sum@jikei.ac.jp
Telephone: +81-3-34331111-3181 Fax: +81-3-34594524
Received: October 13, 2009
Revised: November 19, 2009
Accepted: November 26, 2009
Published online: December 28, 2009
Abstract

AIM: To evaluate the usefulness of a balloon overtube to assist colorectal endoscopic submucosal dissection (ESD) using a gastroscope.

METHODS: The results of 45 consecutive patients who underwent colorectal ESD were analyzed in a single tertiary endoscopy center. In preoperative evaluation of access to the lesion, difficulties were experienced in the positioning and stabilization of a gastroscope in 15 patients who were thus assigned to the balloon-guided ESD group. A balloon overtube was placed with a gastroscope to provide an endoscopic channel to the lesion in cases with preoperatively identified difficulties related to accessibility. Colorectal ESD was performed following standard procedures. A submucosal fluid bleb was created with hyaluronic acid solution. A circumferential mucosal incision was made to marginate the lesion. The isolated lesion was finally excised from the deeper layers with repetitive electrosurgical dissections with needle knives. The success of colorectal ESD, procedural feasibility, and procedure-related complications were the main outcomes and measurements.

RESULTS: The overall en bloc excision rate of colorectal ESD during this study at our institution was 95.6%. En bloc excision of the lesion was successfully achieved in 13 of the 15 patients (86.7%) in the balloon overtube-guided colorectal ESD group, which was comparable to the results of the standard ESD group with better accessibility to the lesion (30/30, 100%, not statistically significant).

CONCLUSION: Use of a balloon overtube can improve access to the lesion and facilitate scope manipulation for colorectal ESD.

Keywords: Balloon overtube; Colorectal neoplasm; Early colorectal cancer; En bloc tumor excision; Endoscopic submucosal dissection; Laterally spreading tumor