Endoscopic submucosal dissection for large superficial colorectal tumors using the "clip-flap method"

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) for colorectal tumors faces challenges due to poor visualization and cutting area instability.
• Achieving mucosal flap formation, which improves visualization, is particularly difficult in colorectal ESD.
• The developed "clip-flap method" addresses these limitations by using endoclips to substitute for a mucosal flap during its formation.

Purpose of the Study:

• To evaluate the efficacy and safety of the novel "clip-flap method" for facilitating mucosal flap formation during colorectal ESD.
• To assess the technical feasibility and clinical outcomes of applying the clip-flap method in treating large superficial colorectal tumors.

Main Methods:

• The clip-flap method was prospectively applied to 114 large superficial colorectal tumors during ESD procedures.
• The technique involved using endoclips to create a temporary "flap" for improved visualization and stability.
• Therapeutic efficacy, including en bloc resection rates, and safety, including intraoperative complications, were assessed.

Main Results:

• The study included 114 patients with large superficial colorectal tumors (mean diameter 32.5 mm).
• The clip-flap method resulted in a high en bloc resection rate of 97.5% with a mean procedure time of 82.0 minutes.
• Endoclips were successfully used to improve visualization (single clip) or stabilize the visual field (cross pattern), with only one case of conservative-treated intraoperative perforation.

Conclusions:

• The clip-flap method is a simple, safe, and effective technique for performing endoscopic submucosal dissection (ESD) on large superficial colorectal tumors.
• This innovative approach overcomes the challenges of mucosal flap formation, enhancing visualization and stability during colorectal ESD.