COLONIC ENDOSCOPIC SUBMUCOSAL DISSECTION USING A NOVEL HOOD THAT STORES DUAL ELASTIC THREADS

Abstract

Direct visualization and sufficient counter-traction of the site to be dissected are essential for safe and efficient endoscopic submucosal dissection (ESD). Recently, several traction methods have been reported. We developed a novel hood that stores two elastic threads in its side pockets, named the Dual Traction Hood, to achieve more efficient traction during submucosal dissection by virtue of double tractions. We report three consecutive cases of deep colonic adenocarcinoma/adenoma treated using the present novel hood that stores dual elastic threads. After circumferential incision and submucosal dissection of the anal edge, the first thread was grasped and fixed to the anal edge by the first endoclip, and another ring of the thread was grasped and fixed to the opposite colonic wall by the second endoclip. The second traction was performed using the second thread in the same manner. By the above procedures, the present hood facilitated successful dual-traction and one-piece resection in all three cases. There were no adverse events during or after the procedures. We report the techniques for ESD using the present hood in conjunction with different endoknives and endoclips.