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DOI: 10.1055/a-1381-6363
Dual-functional use of thread delivery hood for traction-assisted rectal endoscopic submucosal dissection and defect closure
Endoscopic closure of an artificial defect after colorectal endoscopic submucosal dissection (ESD) is useful in preventing adverse events [1], with several closure methods having been developed [2] [3]. While the use of traction facilitates ESD [4], no devices currently exist that can facilitate both traction and closure. An elastic thread delivery hood (Dual Traction Hood; Adachi Co., Ltd., Osaka, Japan and Nomura Medical Device Co., Ltd., Nagano, Japan) that has dual threads with multi-rings inside the cap has been developed for traction use ([Fig. 1]) [5]. We describe a case in which this device was used successfully for traction as well as closure in a rectal ESD ([Video 1]).
Video 1 A Dual Traction Hood was used successfully for traction as well as closure in a rectal endoscopic submucosal dissection.
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A 65-year-old man presented with a rectal neuroendocrine tumor ([Fig. 2]). Rectal ESD was performed using a Dual Traction Hood as follows. The first thread was used for the traction. After a submucosal pocket was created followed by a whole circumferential incision, the thread was released from the hood using a hemoclip (HX-610-090; Olympus, Tokyo, Japan). Using hemoclips, the thread was then fixed to the edge of the pocket and the opposite normal mucosa ([Fig. 3]). Traction-assisted ESD was completed successfully, leaving an artificial defect 30 mm wide ([Fig. 4]).
The second thread was used to close the defect post-ESD. One ring of the thread was anchored to the defect edge using a hemoclip, and another ring was anchored to the opposite edge. The procedure was repeated in a zig-zag pattern while the thread was attached to both edges. Consequently, the defect was approximated by these hemoclips. Complete closure was achieved with additional hemoclips ([Fig. 5]). The ESD and closure took 20 and 15 minutes, respectively.
The Dual Traction Hood enabled clinicians to achieve both traction-assisted ESD and endoscopic defect closure. This method may become an effective option in facilitating ESD and preventing delayed complications.
Endoscopy_UCTN_Code_TTT_1AQ
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Publication History
Article published online:
30 March 2021
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References
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- 4 Saito Y, Parra-Blanco A. Traction is most important for the widespread use of endoscopic submucosal dissection, especially in procedures presenting particular difficulty. Endoscopy 2020; 52: 328-329
- 5 Fujita K, Takeshita M, Moriyama E. et al. Novel technique for endoscopic submucosal dissection using an elastic thread delivery hood. Endoscopy 2020; 52: E178-E180