A new sinker-assisted endoscopic submucosal dissection for colorectal cancer

Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer, but it is not widely used to treat the colorectum because of its degree of technical difficulty. Thus, a noninvasive tool that facilitates the direct visualization of the submucosal layer is needed.

Traction-assisted dissection was performed on 4 superficial lesions. The system consisted of a metallic clip attached by a nylon line to a sinker 6 x 4 x 4 mm in size and weighing 1 g. After partially dissecting the submucosa, the clip was attached to the edge of the exfoliated mucosa and the weight of the sinker pulled down the partly resected lesion.

In all 4 cases, the sinker allowed direct visualization of the cutting line, and en bloc resection was successfully accomplished.

These preliminary results suggest that sinker-assisted ESD is effective for the complete removal of selected superficial early colorectal cancer.