Endoscopy 2019; 51(04): S182
DOI: 10.1055/s-0039-1681710
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 13:30 – 14:00: Colon ESD 2 ePoster Podium 1
Georg Thieme Verlag KG Stuttgart · New York

COLONIC ESD: IS IT EASY WITH COUNTERTRACTION BY CLIP AND RUBBER BAND? A PROSPECTIVE STUDY

J Jacques
1   CHU Dupuytren, Limoges, France
,
J Albouys
1   CHU Dupuytren, Limoges, France
,
J Rivory
2   Edouard Herriot University Hospital, Lyon, France
,
R Legros
1   CHU Dupuytren, Limoges, France
,
T Ponchon
2   Edouard Herriot University Hospital, Lyon, France
,
D Sautereau
1   CHU Dupuytren, Limoges, France
,
M Pioche
2   Edouard Herriot University Hospital, Lyon, France
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

ESD in the colon is more challenging technically than other locations.

New systematic strategy by countertraction by clips and rubber band considerably facilitate the procedure. Here, we report a large prospective case series of colon ESD using This strategy.

Methods:

Prospective consecutive sudy of all colonic ESD performed prospectively two experts centers from Avril 2017 (First Colonic ESD with clips and rubber band) to November 2018. Since the first case of colonic ESD with clips and rubber band in April 2017, all cases of colonic ESD were performed using this strategy.

Primary Endpoint: Monobloc, RO and curative resection rate.

Secondary Endpoints: Perforation rate, risk factors in multivariate analysis of Perforation, R0 resection and Optimal ESD (defined by R0 resection without perforation and faster than 20 mm2/min).

Results:

440 colorectal ESD were performed in the study period. 286 cases were included in the study (Exclusion of rectal cases) performed by 4 operators.

Lesions were SMSA 4 in 82% of cases with a mean size of 55 mm. Mean duration procedure was 80 min with a min speed of resection at 34,1 mm2/min. 70% of the lesions were located above the splenic flexure.

Primary Endpoint: Monobloc, R0 and curative resection rate were respectively 96%, 81,2% and 74%.

Secondary Endpoint:

  • Perforation rate was 4,3%

  • predictive factors of optimal ESD were one operator (OR 3,92; p = 0,0002) and no F2 fibrosis (OR 4,23, p = 0,037) in multivariate analysis

  • predictive factors of non R0 resection was only a location on the ileocecal valvular (OR 4,32; p = 0,025) in multivariate analysis

  • no predictive factors of perforation was individualized in multivariate analysis.

Conclusions:

Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD and feeds the debate between pEMR and ESD for the treatment of large colonic superficial lesions.