| セッション情報 |
International Session4(消化器内視鏡学会・消化器病学会合同)
Achieving high quality colorectal ESD
|
| タイトル |
内IS4-1：Colorectal ESD performed using clip flap method
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| 演者 |
K. Yamamoto（Department of Gastroenterology, Toyonaka Municipal Hospital） |
| 共同演者 |
S. Hayashi（Department of Gastroenterology, Toyonaka Municipal Hospital）, M. Ichiba（Department of Gastroenterology, Toyonaka Municipal Hospital） |
| 抄録 |
Background and Aims: Endoscopic submucosal dissection (ESD) is technically difficult due to poor visualization and instability in the cutting area. The most difficult part of the procedure is formation of the mucosal flap, which improves visibility of the cutting area and allows for easier dissection. We designed clip flap method which is used an endoclip as a substitute for the mucosal flap. (Endoscopy, 2012). Here, we evaluated the efficacy and safety of clip flap method in colorectal ESD. ESD was performed for 78 superficial colorectal tumors larger than 20 mm in diameter as follows. After circumferential mucosal incision, the exfoliated mucosa was clipped with one or more endoclips. The endoscope attachment was slipped under the endoclip, and then the submucosal layer was dissected. Results: Median tumor diameter, resected specimen diameter, and procedure time was 30mm, 37mm, 65minutes. En-bloc resection rate is 97.4%. No severe complications occurred. In all cases, the submucosal layer was clearly visualized and dissected efficiently by counter-traction using the endoclip once the attachment had been slipped under the endoclip. Respiratoty fluctuation in the cutting area was reduced and the visual field stabilized because the attachment was supposed by the endoclip. The endoclip weight provided counter-traction, and the direction of gravity could be controlled by a postural change. Conclusions: Clip flap method very effectively enabled formation of the mucosal flap and contributed to safe colorectal ESD. |
| 索引用語 |
clip flap, endoscopic submucosal dissection |
