2017 Volume 59 Issue 7 Pages 1514-1523
Endoscopic submucosal dissection (ESD) allows en bloc resection of large gastrointestinal neoplasms regardless of their size. However, ESD is difficult to perform and it is associated with a longer procedure time and higher risk of complications such as perforation than endoscopic mucosal resection (EMR). To address this difficulty, several traction methods have been introduced to facilitate ESD procedure.
We designed a traction device called the S-O clip (Zeon Medical Co., Ltd., Tokyo, Japan) and reported it previously. The S-O clip consists of a metallic clip attached to the end of a spring, which is connected at its other end to a nylon loop. It can be passed through an endoscope instrument channel and can easily pull a lesion at any location up without withdrawing the endoscope. We describe the basic and recommended usage of the S-O clip.
1. A circumferential incision around the tumor in the submucosal layer is performed.
2. After separation of the tumor from the surrounding normal mucosa, an S-O clip is attached to the edge of the exfoliated mucosa.
3. A regular clip is used to grasp the distal nylon loop attached to the S-O clip and then the regular clip is inserted and applied to the colon wall opposite the lesion, enabling traction and therefore opening the resection margin.
4. The traction applied by the S-O clip pulls on the edge of the lesion, allowing the cutting line in the submucosal layer to be visualized and resulting in safe and successful en bloc dissection.
5. After dissection, the nylon loop is cut with a knife, and the specimen is brought out using the forceps. The endoscope is not withdrawn during the entire procedure.
S-O clip-assisted ESD is safe and effective for en bloc resection of large superficial neoplasms in the colorectum.
