Colorectal Endoscopic Submucosal Dissection Using Band Traction Device (Btd) For A Novice Endoscopist And The Possibility Of Applying Submucosal Tunnel Creation With Btd

Colorectal endoscopic submucosal dissection (ESD) can be technically difficult for various reasons such as submucosal fibrosis and a thin muscularis layer, which can lead to increased perforation rates and procedure time. When initially performing colorectal ESD, to facilitate a safe and efficient procedure, we use a band traction device (BTD) designed to be fixed with clips on the free edges of a mucosal overlay to deflect the diseased mucosa away from the dissection plane during submucosal dissection. We aimed to evaluate the usefulness of BTD during colorectal ESD as needed by trainee endoscopists. We retrospectively investigated outcomes of 200 colorectal ESDs performed under the supervision of ESD experts by one trainee endoscopist who had sufficient knowledge of intubation techniques beforehand, but no experience with ESD. We divided the trainee’s 200 cases into three separate terms as follows: cases 1–50, 51–100, and 101–200 were designated as initial, middle, and late periods, respectively. Notably, in the late period, the trainee’s rate of accomplishing single-handed ESD was as high as 99%. By contrast, use of BTD decreased with increasing ESD experience. Using BTD for colorectal ESD enabled the trainee to perform colorectal ESD effectively and safely even in the initial period. In addition, to overcome these difficulties, a novel strategy, either the submucosal pocket or tunnel creation method, was recently reported. However, mucosal flap formation is initially the most important and difficult step in conducting procedures related to colorectal ESD. To enable a safer and more efficient colorectal ESD procedure, we combined the submucosal tunnel creation method with BTD. Without an initial mucosal incision, BTD was connected to the anal mucosa at approximately 10 mm from the distal side of the tumor after submucosal injection. When repeated incision and dissection were performed in this situation, submucosal tunnel creation was facilitated. Consequently, creating a submucosal tunnel using BTD becomes much easier. This application may safely achieve an en bloc and efficient resection of colorectal neoplasms.