New methodClinical endoscopyEndoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction (with video)
Section snippets
Design of the spring S-O clip
The spring S-O clip consists of a metal clip attached to the end of a 7-mm long and 1.8-mm wide spring, which is connected at its other end to a double nylon loop (Fig. 1). The spring S-O clip can be passed through an endoscope instrument channel (Fig. 2). The length of the spring, which is not altered by a 1g force, extends approximately 10-fold at 20g.
S-O clip procedure
A conventional endoscope with a single instrument channel (PCF -Q240I; Olympus Optical Co. Ltd., Tokyo, Japan) was used for ESD. A
Results
All 3 spring S-O clip-assisted ESDs were performed safely; lesions were resected en bloc successfully and without complications. Fitting the spring S-O clip to each lesion was easy and required an average of only 2 minutes. Total procedure times were 44, 27, and 49 minutes for Patients 1, 2, and 3, respectively. Although circumferential cutting of normal tissues required 22, 14, and 24 minutes, respectively, the submucosal dissection time for each patient was approximately 20 minutes.
Discussion
The small angulated lumen and thinner wall in the colorectum increases the risk of complications with colorectal ESD relative to gastric ESD. For this reason, it is important to improve visualization of the cutting line in the submucosal layer. The spring S-O clip permits direct submucosal layer visualization and facilitates en bloc resection of large superficial colorectal tumors.
Various traction devices and techniques have been applied previously to facilitate ESD, including percutaneous
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