CLINICAL EXPERIENCE OF ONE-MAN METHOD OF ESD USING FLUSH KNIFE FOR COLORECTAL TUMOR

Abstract

Background : Endoscopic submucosal dissection (ESD) for colorectal tumors enables us to achieve en-bloc resection of large tumors which is not able to be by EMR (endoscopic mucosal resection). In ESD, it is important to shorten the operation time to minimize the patient's abdominal fullness. Furthermore, it is a problem to need many medical staffs for ESD in undermanned medical institution. In the current study, we developed the new one-man method of ESD to solve these problems. Methods : We studied 152 colorectal tumors that were treated by ESD at Kyoto Prefectural University of Medicine or Nara City Hospital between 2007 and 2009. In these, 64 cases were treated by new one-man method and 88 cases were by previous method. The 88 cases of previous method were divided into 2 groups based on the date of procedure ; the preceding group (44 cases) and the last group (44 cases). Tumor size, operation time, rate of en-bloc resection, and complications were analyzed in these 3 groups. The one-man method of ESD was performed using Flush knife with automatic injection device. Original device, which was made of paper clip and clothespin, was used to connect knife and endoscope. Results : ESD with the new method was accomplished in all 64 cases. The method enabled us to reduce medical staff who held knife during ESD. The average tumor size, rate of en-bloc resection, and rate of perforation and postoperative hemorrhage as a complication was not different significantly among the 3 groups. The average operation time was slightly shorter in the new method group, i. e. preceding group, 110 min ; last group, 112 min ; new method group, 97 min. Conclusions : The new one-man method of ESD has the possibility for shortening operation time and reduction of medical staffs during ESD.