Subscribe to RSS
DOI: 10.1055/s-0044-100720
Balloon-assisted endoscopy facilitates endoscopic submucosal dissection of difficult superficial proximal colon tumors
Publication History
submitted 04 July 2017
accepted after revision 16 December 2017
Publication Date:
12 February 2018 (online)
![](https://www.thieme-connect.de/media/endoscopy/201808/lookinside/thumbnails/15826_10-1055-s-0044-100720-1.jpg)
Abstract
Background Colorectal endoscopic submucosal dissection (ESD) can be technically difficult in some situations, such as paradoxical movement of the proximal colon. The double-balloon endoscope provides stable endoscopic maneuvering, even in the small intestine. The aim of this study was to assess the outcomes of balloon-assisted endoscopic submucosal dissection (BAESD) of colonoscopically difficult superficial proximal colon tumors.
Methods We retrospectively reviewed the records of patients who underwent BAESD of superficial proximal colon tumors where colonoscopic difficulties were encountered, from January 2011 to September 2016. Difficulties were defined as a previous incomplete colonoscopy using a conventional colonoscope or unstable endoscopic maneuverability around the tumor with a conventional colonoscope. A propensity score model was used as a secondary analysis to compare outcomes of the BAESD group with those of a non-BAESD group.
Results BAESD was performed on 63 tumors in 63 patients. En bloc resection was achieved for 62 tumors (98 %) and an R0 resection was achieved for 55 tumors (87 %). Propensity score matching analysis created 59 matched pairs from the BAESD and non-BAESD groups. There were no statistically significant differences between the two groups in en bloc resection (100 % vs. 100 %; P > 0.99), R0 resection (90 % vs. 93 %; P = 0.74), perforation (0 % vs. 2 %; P > 0.99) or postoperative bleeding (3 % vs. 0 %; P = 0.50).
Conclusion Balloon-assisted endoscopy achieved safe and reliable ESD of colonoscopically difficult superficial proximal colon tumors.
-
References
- 1 World Cancer Research Fund International. Colorectal cancer statistics. Available from: http://www.wcrf.org/int/cancer-facts-figures/data-specific-cancers/colorectal-cancer-statistics [Accessed: 3 December 2017]
- 2 World Health Organization. The global burden of disease: 2004 update. Available from: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf [Accessed: 3 December 2017]
- 3 Cucino C, Buchner AM, Sonnenberg A. Continued rightward shift of colorectal cancer. Dis Colon Rectum 2002; 45: 1035-1040
- 4 Saltzstein SL, Behling CA. Age and time as factors in the left-to-right shift of the subsite of colorectal adenocarcinoma: a study of 213,383 cases from the California Cancer Registry. J Clin Gastroenterol 2007; 4: 173-177
- 5 Shah HA, Paszat LF, Saskin R. et al. Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology 2007; 132: 2297-2303
- 6 Rex DK, Chen SC, Overhiser AJ. Colonoscopy technique in consecutive patients referred for prior incomplete colonoscopy. Clin Gastroenterol Hepatol 2007; 5: 879-883
- 7 Yamamoto H, Sekine Y, Sato Y. et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 2001; 53: 216-220
- 8 Gay G, Delvaux M. Double-balloon colonoscopy after failed conventional colonoscopy: a pilot series with a new instrument. Endoscopy 2007; 39: 788-792
- 9 Pasha SF, Harrison ME, Das A. et al. Utility of double-balloon colonoscopy for completion of colon examination after incomplete colonoscopy with conventional colonoscope. Gastrointest Endosc 2007; 65: 848-853
- 10 Hotta K, Katsuki S, Ohata K. et al. A multicenter, prospective trial of total colonoscopy using a short double-balloon endoscope in patients with previous incomplete colonoscopy. Gastrointest Endosc 2012; 75: 813-818
- 11 Ono H, Kondo H, Gotoda T. et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48: 225-229
- 12 Fujishiro M, Yahagi N, Kakushima N. et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 2007; 5: 678-683
- 13 Takeuchi Y, Uedo N, Iishi H. et al. Endoscopic submucosal dissection with insulated-tip knife for large mucosal early gastric cancer: a feasibility study (with videos). Gastrointest Endosc 2007; 66: 186-193
- 14 Yamamoto H, Yahagi N, Oyama T. Mucosectomy in the colon with endoscopic submucosal dissection. Endoscopy 2005; 37: 764-768
- 15 Yamamoto H. Endoscopic submucosal dissection – current success and future directions. Nat Rev Gastroenterol Hepatol 2012; 9: 519-529
- 16 Ino Y, Yamamoto H, Miura Y. et al. Colonic ESD using double balloon endoscopy and SAFEKnifeV. (In Japanese with English abstract) Stomach Intestine 2013; 48: 164-172
- 17 Dzeletovic I, Harrison ME, Pasha SF. et al. Comparison of single- versus double-balloon assisted-colonoscopy for colon examination after previous incomplete standard colonoscopy. Dig Dis Sci 2012; 57: 2680-2686
- 18 Hotta K, Katsuki S, Ohata K. et al. Efficacy and safety of endoscopic interventions using the short double-balloon endoscope in patients after incomplete colonoscopy. Dig Endosc 2015; 27: 95-98
- 19 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-577
- 20 Nakajima T, Saito Y, Tanaka S. et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 2013; 27: 3262-3270
- 21 Sakamoto H, Hayashi Y, Miura Y. et al. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open 2017; 5: E123-E129
- 22 Hayashi Y, Shinozaki S, Sunada K. et al. Efficacy and safety of endoscopic submucosal dissection for superficial colorectal tumors more than 50 mm in diameter. Gastrointest Endosc 2016; 83: 602-607
- 23 Hayashi Y, Sunada K, Yamamoto H. Prototype holder adequately supports the overtube in balloon-assisted endoscopic submucosal dissection. Dig Endosc 2014; 26: 682
- 24 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
- 25 National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0. Available from: http://evs.nci.nih.gov/ftp1/CTCAE/About.html [Accessed: 3 December 2017]
- 26 Takeuchi Y, Iishi H, Tanaka S. et al. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis 2014; 29: 1275-1284
- 27 Imai K, Hotta K, Yamaguchi Y. et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc 2016; 83: 954-962
- 28 Sunada K, Yamamoto H. Double-balloon endoscopy: past, present, and future. J Gastroenterol 2009; 44: 1-12
- 29 Ohya T, Ohata K, Sumiyama K. et al. Balloon overtube-guided colorectal endoscopic submucosal dissection. World J Gastroenterol 2009; 15: 6086-6090
- 30 Asayama N, Oka S, Tanaka S. et al. Clinical usefulness of a single-use splinting tube for poor endoscope operability in deep colonic endoscopic submucosal dissection. Endosc Int open 2016; 4: E614-E617