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Novel and effective countertraction using a ring-shaped thread for safer gastric and colorectal endoscopic submucosal dissection
Accepted Manuscript Novel and effective countertraction using the ring-shaped thread for safer gastric and colorectal endoscopic submucosal dissection Hirohito Mori, MD, PhD, Asadur Rahman, MS, PhD, Hideki Kobara, MD, PhD, Shintaro Fujihara, MD, PhD, Noriko Nishiyama, MD, PhD, Tsutomu Masaki, MD, PhD PII:
S0016-5107(16)30117-1
DOI:
10.1016/j.gie.2016.04.033
Reference:
YMGE 9992
To appear in:
Gastrointestinal Endoscopy
Received Date: 23 February 2016 Accepted Date: 25 April 2016
Please cite this article as: Mori H, Rahman A, Kobara H, Fujihara S, Nishiyama N, Masaki T, Novel and effective countertraction using the ring-shaped thread for safer gastric and colorectal endoscopic submucosal dissection, Gastrointestinal Endoscopy (2016), doi: 10.1016/j.gie.2016.04.033. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Novel and effective countertraction using the ring-shaped thread for safer gastric and colorectal endoscopic submucosal dissection
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Hirohito Mori, MD, PhD1; Asadur Rahman, MS, PhD2; Hideki Kobara, MD, PhD1; Shintaro
Departments of Gastroenterology and Neurology, 2Department of Pharmacology, Faculty of
Medicine, Kagawa University, Japan
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Fujihara, MD, PhD1 ; Noriko Nishiyama, MD, PhD1; Tsutomu Masaki, MD, PhD1
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Running head: Countertraction using ring-shaped thread
Corresponding Author: Hirohito Mori, MD, PhD Department of Gastroenterology and Neurology
EP
Faculty of Medicine, Kagawa University 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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Tel.: +81-87-891-2156; Fax: +81-87-891-2158 E-mail: [email protected] The authors authors declare no conflicts of interest. interest.
1
ACCEPTED MANUSCRIPT Because the delivery and ease of use for safer endoscopic dissection (ESD) can not yet be overcome, a simple and effective countertraction is necessary. A 58-year-old man was diagnosed with early gastric cancer. It was difficult to continue ESD due to gravity direction. Two 10-mm ring threads were inserted into the stomach for clipping
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both the affected side and the contralateral side; thereby the lesion was lifted (Figure 1A, 1B). Countertraction was applied by air insufflation (Figure 1C), which made ESD easier and safer.
A 62-year-old woman was diagnosed with early rectal cancer. It was difficult to initiate ESD
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because there was no entry space. An 8-mm ring-shaped thread was inserted into the rectum (Figure 1D, 1E). Sufficient countertraction was obtained by adjusting the amount of CO2
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(Figure 1F).
Because the basic principle was to create stronger countertraction by using expanding force by insufflation, which was quite different from other mechanical tractions such as the clip with line method used by Oyama et al, it was more suitable for difficult situations with
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severe fibrosis under which stronger countertraction by insufflation allowed us to presume
Figure Legends Legends
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the cutting line between the submucosa and the muscularis propria.
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Figure 1A, Two 10-mm ring threads were inserted into the stomach for clipping both of the affected sides of greater curvature and contralateral side; thereby, the lesion was lifted. B, By using local injection and CO2 insufflation, we obtained sufficient bulging. There was no adverse event from this method, and also no limitation relating the location of lesion wherever the ring-shaped thread was clipped at the edge of resected lesion, and lifted up to the contralateral gastric mucosa. C, By air insufflation, stronger countertraction was obtained. The only pitfall was that the thread had to be hooked and lifted up under deflation to obtain stronger counter traction by subsequent insufflation. D, The lesion was in the lower rectum. E, Because it was difficult to obtain sufficient bulging by local injection, an 8-mm 2
ACCEPTED MANUSCRIPT ring-shaped thread was placed and lifted up the edge of the lesion. F, In proportion to the amount of insufflated and deflated CO2, it was possible to adjust the strength of countertraction with the ring-shaped thread.
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Video: Background, case 1 (gastric ESD) , case 2 (rectal ESD) and technique highlights.
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S0016-5107(16)30117-1
DOI:
10.1016/j.gie.2016.04.033
Reference:
YMGE 9992
To appear in:
Gastrointestinal Endoscopy
Received Date: 23 February 2016 Accepted Date: 25 April 2016
Please cite this article as: Mori H, Rahman A, Kobara H, Fujihara S, Nishiyama N, Masaki T, Novel and effective countertraction using the ring-shaped thread for safer gastric and colorectal endoscopic submucosal dissection, Gastrointestinal Endoscopy (2016), doi: 10.1016/j.gie.2016.04.033. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Novel and effective countertraction using the ring-shaped thread for safer gastric and colorectal endoscopic submucosal dissection
RI PT
Hirohito Mori, MD, PhD1; Asadur Rahman, MS, PhD2; Hideki Kobara, MD, PhD1; Shintaro
Departments of Gastroenterology and Neurology, 2Department of Pharmacology, Faculty of
Medicine, Kagawa University, Japan
M AN U
1
SC
Fujihara, MD, PhD1 ; Noriko Nishiyama, MD, PhD1; Tsutomu Masaki, MD, PhD1
TE D
Running head: Countertraction using ring-shaped thread
Corresponding Author: Hirohito Mori, MD, PhD Department of Gastroenterology and Neurology
EP
Faculty of Medicine, Kagawa University 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
AC C
Tel.: +81-87-891-2156; Fax: +81-87-891-2158 E-mail: [email protected] The authors authors declare no conflicts of interest. interest.
1
ACCEPTED MANUSCRIPT Because the delivery and ease of use for safer endoscopic dissection (ESD) can not yet be overcome, a simple and effective countertraction is necessary. A 58-year-old man was diagnosed with early gastric cancer. It was difficult to continue ESD due to gravity direction. Two 10-mm ring threads were inserted into the stomach for clipping
RI PT
both the affected side and the contralateral side; thereby the lesion was lifted (Figure 1A, 1B). Countertraction was applied by air insufflation (Figure 1C), which made ESD easier and safer.
A 62-year-old woman was diagnosed with early rectal cancer. It was difficult to initiate ESD
SC
because there was no entry space. An 8-mm ring-shaped thread was inserted into the rectum (Figure 1D, 1E). Sufficient countertraction was obtained by adjusting the amount of CO2
M AN U
(Figure 1F).
Because the basic principle was to create stronger countertraction by using expanding force by insufflation, which was quite different from other mechanical tractions such as the clip with line method used by Oyama et al, it was more suitable for difficult situations with
TE D
severe fibrosis under which stronger countertraction by insufflation allowed us to presume
Figure Legends Legends
EP
the cutting line between the submucosa and the muscularis propria.
AC C
Figure 1A, Two 10-mm ring threads were inserted into the stomach for clipping both of the affected sides of greater curvature and contralateral side; thereby, the lesion was lifted. B, By using local injection and CO2 insufflation, we obtained sufficient bulging. There was no adverse event from this method, and also no limitation relating the location of lesion wherever the ring-shaped thread was clipped at the edge of resected lesion, and lifted up to the contralateral gastric mucosa. C, By air insufflation, stronger countertraction was obtained. The only pitfall was that the thread had to be hooked and lifted up under deflation to obtain stronger counter traction by subsequent insufflation. D, The lesion was in the lower rectum. E, Because it was difficult to obtain sufficient bulging by local injection, an 8-mm 2
ACCEPTED MANUSCRIPT ring-shaped thread was placed and lifted up the edge of the lesion. F, In proportion to the amount of insufflated and deflated CO2, it was possible to adjust the strength of countertraction with the ring-shaped thread.
Video Legends Legends
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TE D
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SC
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Video: Background, case 1 (gastric ESD) , case 2 (rectal ESD) and technique highlights.
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TE D
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