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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(02): E210-E215
DOI: 10.1055/a-1313-7026
Original article

Palisade technique as an effective endoscopic submucosal dissection tool for large colorectal tumors

Yuichiro Suzuki
1   Department of Gastrointestinal Endoscopy, NTT Medical Center, Tokyo, Japan
,
Ken Ohata
1   Department of Gastrointestinal Endoscopy, NTT Medical Center, Tokyo, Japan
,
Eiji Sakai
1   Department of Gastrointestinal Endoscopy, NTT Medical Center, Tokyo, Japan
,
Ryoju Negishi
1   Department of Gastrointestinal Endoscopy, NTT Medical Center, Tokyo, Japan
,
Maiko Takita
1   Department of Gastrointestinal Endoscopy, NTT Medical Center, Tokyo, Japan
,
Yohei Minato
1   Department of Gastrointestinal Endoscopy, NTT Medical Center, Tokyo, Japan
,
Takeshi Muramoto
1   Department of Gastrointestinal Endoscopy, NTT Medical Center, Tokyo, Japan
,
Hideyuki Chiba
2   Department of Gastroenterology, Omori Red Cross hospital, Tokyo, Japan
,
Yosuke Tsuji
3   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
,
Nobuyuki Matsuhashi
4   Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
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Abstract

Background and study aims Endoscopic submucosal dissection (ESD) has become the standard treatment for colorectal ESD, but large colorectal tumors remain difficult to remove. We developed a new method, called the palisade technique, by modifying the multiple tunneling technique. In this method, a palisade of submucosal tissue is left beneath the tumor to anchor a dissected specimen, maintaining effective submucosal traction.

Patients and methods The study included 11 patients with large colorectal tumors that were over half the circumference of the colorectal lumen which were treated using the palisade technique from August 2017 to October 2019. Overall resection outcomes were assessed.

Results All 11 lesions were removed en bloc. The R0 resection rate was 45.6 % because of marginal burning of the specimen, but no local recurrence was found after a median observation period of 31 months. The median submucosal dissection time (SDT) and submucosal dissection speed (SDS) were 170 minutes and 23.1 mm2/min, respectively. One case of post-ESD hemorrhage was successfully managed endoscopically, and two cases of post-colorectal ESD coagulation syndrome were managed conservatively.

Conclusion The palisade technique can be an effective and safe technique for treating large colorectal tumors that extend over half the luminal circumference.



Publication History

Received: 03 June 2020

Accepted: 02 October 2020

Article published online:
03 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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