Endoscopy 2015; 47(03): 262-265
DOI: 10.1055/s-0034-1390739
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection for large superficial colorectal tumors using the “clip-flap method”

Katsumi Yamamoto
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
2  Endoscopy Center, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
,
Shiro Hayashi
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
,
Hirotsugu Saiki
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
,
Naohiko Indo
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
,
Tasuku Nakabori
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
,
Masashi Yamamoto
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
,
Mitsuhiko Shibuya
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
,
Tsutomu Nishida
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
,
Makoto Ichiba
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
,
Masami Inada
1  Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
› Author Affiliations
Further Information

Publication History

submitted 26 February 2014

accepted after revision 25 July 2014

Publication Date:
20 November 2014 (online)

Background and study aims: Endoscopic submucosal dissection (ESD) is technically difficult because of poor visualization and instability in the cutting area. Although mucosal flap formation improves visualization of the cutting area, it is difficult to achieve, especially in colorectal ESD. To facilitate mucosal flap formation, we developed the “clip-flap method” by substituting an endoclip for the mucosal flap until it is formed.

Patients and methods: The clip-flap method was applied to 114 of 119 large superficial colorectal tumors being treated by ESD. Therapeutic efficacy and safety were assessed.

Results: Mean tumor diameter, resected specimen diameter, and procedure time were 32.5 mm, 38.9 mm, and 82.0 minutes, respectively. The en bloc resection rate was 97.5 %. Intraoperative perforation occurred in one patient who was treated conservatively. A single endoclip was used for 92 lesions and improved visualization of the cutting area. A cross pattern of endoclips was used for 22 lesions and further stabilized the visual field, especially near the lateral side.

Conclusions: The clip-flap method is a simple, safe, and effective option for ESD of large superficial colorectal tumors.