糸付きクリップによる牽引補助下大腸 ESd の有効性:前向き無作為化試験(動画付き)

Translated title of the contribution: Efficacy of traction-assisted colorectal endoscopic submucosal dissection using a clip-and-thread technique: A prospective randomized study (with videos)

Yasushi Yamasaki, Yoji Takeuchi, Noriya Uedo, Takashi Kanesaka, Minoru Kato, Kenta Hamada, Yusuke Tonai, Noriko Matsuura, Tomofumi Akasaka, Noboru Hanaoka, Koji Higashino, Ryu Ishihara, Hiroyuki Okada, Hiroyasu Iishi

Research output: Contribution to journalArticle

Abstract

Background and Aim: Colorectal endoscopic submucosal dissection (ESD) remains challenging because of technical difficulties, long procedure time, and high risk of adverse events. To facilitate colorectal ESD, we developed traction-assisted colorectal ESD using a clip and thread (TAC-ESD) and conducted a randomized controlled trial to evaluate its efficacy. Methods: Patients with superficial colorectal neoplasms (SCN) ≥ 20 mm were enrolled and randomly assigned to the conventional- ESD group or to the TAC-ESD group. SCN ≤ 50 mm were treated by two intermediates, and SCN >50 mm were treated by two experts. Primary endpoint was procedure time. Secondary endpoints were TAC-ESD success rate (sustained application of the clip and thread until the end of the procedure), self-completion rate by the intermediates, and adverse events. Results: Altogether, 42 SCN were analyzed in each ESD group (conventional and TAC). Procedure time (median [range]) for the TAC-ESD group was significantly shorter than that for the conventional- ESDgroup (40 [11-86] min vs 70[30-180] min, respectively; P < 0.0001). Success rate of TAC-ESD was 95% (40/42). The intermediates self-completion rate was significantly higher for the TAC-ESD group than for the conventional-ESD group (100% [39/ 39] vs 90% [36/40], respectively; P = 0.04). Adverse events included one intraoperative perforation in the conventional-ESD group and one delayed perforation in the TAC-ESD group. Conclusion: Traction-assisted colorectal endoscopic submucosal dissection reduced the procedure time and increased the self-completion rate by the intermediates (UMIN000018612).

Original languageJapanese
Pages (from-to)192-204
Number of pages13
JournalGASTROENTEROLOGICAL ENDOSCOPY
Volume61
Issue number2
DOIs
Publication statusPublished - Feb 1 2019

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Traction
Surgical Instruments
Prospective Studies
Colorectal Neoplasms
Endoscopic Mucosal Resection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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糸付きクリップによる牽引補助下大腸 ESd の有効性:前向き無作為化試験(動画付き). / Yamasaki, Yasushi; Takeuchi, Yoji; Uedo, Noriya; Kanesaka, Takashi; Kato, Minoru; Hamada, Kenta; Tonai, Yusuke; Matsuura, Noriko; Akasaka, Tomofumi; Hanaoka, Noboru; Higashino, Koji; Ishihara, Ryu; Okada, Hiroyuki; Iishi, Hiroyasu.

In: GASTROENTEROLOGICAL ENDOSCOPY, Vol. 61, No. 2, 01.02.2019, p. 192-204.

Research output: Contribution to journalArticle

Yamasaki, Y, Takeuchi, Y, Uedo, N, Kanesaka, T, Kato, M, Hamada, K, Tonai, Y, Matsuura, N, Akasaka, T, Hanaoka, N, Higashino, K, Ishihara, R, Okada, H & Iishi, H 2019, '糸付きクリップによる牽引補助下大腸 ESd の有効性:前向き無作為化試験(動画付き)', GASTROENTEROLOGICAL ENDOSCOPY, vol. 61, no. 2, pp. 192-204. https://doi.org/10.11280/gee.61.192
Yamasaki, Yasushi ; Takeuchi, Yoji ; Uedo, Noriya ; Kanesaka, Takashi ; Kato, Minoru ; Hamada, Kenta ; Tonai, Yusuke ; Matsuura, Noriko ; Akasaka, Tomofumi ; Hanaoka, Noboru ; Higashino, Koji ; Ishihara, Ryu ; Okada, Hiroyuki ; Iishi, Hiroyasu. / 糸付きクリップによる牽引補助下大腸 ESd の有効性:前向き無作為化試験(動画付き). In: GASTROENTEROLOGICAL ENDOSCOPY. 2019 ; Vol. 61, No. 2. pp. 192-204.
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abstract = "Background and Aim: Colorectal endoscopic submucosal dissection (ESD) remains challenging because of technical difficulties, long procedure time, and high risk of adverse events. To facilitate colorectal ESD, we developed traction-assisted colorectal ESD using a clip and thread (TAC-ESD) and conducted a randomized controlled trial to evaluate its efficacy. Methods: Patients with superficial colorectal neoplasms (SCN) ≥ 20 mm were enrolled and randomly assigned to the conventional- ESD group or to the TAC-ESD group. SCN ≤ 50 mm were treated by two intermediates, and SCN >50 mm were treated by two experts. Primary endpoint was procedure time. Secondary endpoints were TAC-ESD success rate (sustained application of the clip and thread until the end of the procedure), self-completion rate by the intermediates, and adverse events. Results: Altogether, 42 SCN were analyzed in each ESD group (conventional and TAC). Procedure time (median [range]) for the TAC-ESD group was significantly shorter than that for the conventional- ESDgroup (40 [11-86] min vs 70[30-180] min, respectively; P < 0.0001). Success rate of TAC-ESD was 95{\%} (40/42). The intermediates self-completion rate was significantly higher for the TAC-ESD group than for the conventional-ESD group (100{\%} [39/ 39] vs 90{\%} [36/40], respectively; P = 0.04). Adverse events included one intraoperative perforation in the conventional-ESD group and one delayed perforation in the TAC-ESD group. Conclusion: Traction-assisted colorectal endoscopic submucosal dissection reduced the procedure time and increased the self-completion rate by the intermediates (UMIN000018612).",
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AU - Yamasaki, Yasushi

AU - Takeuchi, Yoji

AU - Uedo, Noriya

AU - Kanesaka, Takashi

AU - Kato, Minoru

AU - Hamada, Kenta

AU - Tonai, Yusuke

AU - Matsuura, Noriko

AU - Akasaka, Tomofumi

AU - Hanaoka, Noboru

AU - Higashino, Koji

AU - Ishihara, Ryu

AU - Okada, Hiroyuki

AU - Iishi, Hiroyasu

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N2 - Background and Aim: Colorectal endoscopic submucosal dissection (ESD) remains challenging because of technical difficulties, long procedure time, and high risk of adverse events. To facilitate colorectal ESD, we developed traction-assisted colorectal ESD using a clip and thread (TAC-ESD) and conducted a randomized controlled trial to evaluate its efficacy. Methods: Patients with superficial colorectal neoplasms (SCN) ≥ 20 mm were enrolled and randomly assigned to the conventional- ESD group or to the TAC-ESD group. SCN ≤ 50 mm were treated by two intermediates, and SCN >50 mm were treated by two experts. Primary endpoint was procedure time. Secondary endpoints were TAC-ESD success rate (sustained application of the clip and thread until the end of the procedure), self-completion rate by the intermediates, and adverse events. Results: Altogether, 42 SCN were analyzed in each ESD group (conventional and TAC). Procedure time (median [range]) for the TAC-ESD group was significantly shorter than that for the conventional- ESDgroup (40 [11-86] min vs 70[30-180] min, respectively; P < 0.0001). Success rate of TAC-ESD was 95% (40/42). The intermediates self-completion rate was significantly higher for the TAC-ESD group than for the conventional-ESD group (100% [39/ 39] vs 90% [36/40], respectively; P = 0.04). Adverse events included one intraoperative perforation in the conventional-ESD group and one delayed perforation in the TAC-ESD group. Conclusion: Traction-assisted colorectal endoscopic submucosal dissection reduced the procedure time and increased the self-completion rate by the intermediates (UMIN000018612).

AB - Background and Aim: Colorectal endoscopic submucosal dissection (ESD) remains challenging because of technical difficulties, long procedure time, and high risk of adverse events. To facilitate colorectal ESD, we developed traction-assisted colorectal ESD using a clip and thread (TAC-ESD) and conducted a randomized controlled trial to evaluate its efficacy. Methods: Patients with superficial colorectal neoplasms (SCN) ≥ 20 mm were enrolled and randomly assigned to the conventional- ESD group or to the TAC-ESD group. SCN ≤ 50 mm were treated by two intermediates, and SCN >50 mm were treated by two experts. Primary endpoint was procedure time. Secondary endpoints were TAC-ESD success rate (sustained application of the clip and thread until the end of the procedure), self-completion rate by the intermediates, and adverse events. Results: Altogether, 42 SCN were analyzed in each ESD group (conventional and TAC). Procedure time (median [range]) for the TAC-ESD group was significantly shorter than that for the conventional- ESDgroup (40 [11-86] min vs 70[30-180] min, respectively; P < 0.0001). Success rate of TAC-ESD was 95% (40/42). The intermediates self-completion rate was significantly higher for the TAC-ESD group than for the conventional-ESD group (100% [39/ 39] vs 90% [36/40], respectively; P = 0.04). Adverse events included one intraoperative perforation in the conventional-ESD group and one delayed perforation in the TAC-ESD group. Conclusion: Traction-assisted colorectal endoscopic submucosal dissection reduced the procedure time and increased the self-completion rate by the intermediates (UMIN000018612).

KW - Clip and thread

KW - Colorectal neoplasm(

KW - Endoscopic submucosal dissection(

KW - Procedure time

KW - Traction

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