Endoscope rotating technique is useful for difficult colorectal endoscopic submucosal dissection

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Colorectal Cancer Treatment

Background:

• Conventional lesion-up colorectal endoscopic submucosal dissection (ESD) carries a risk of perforation.
• The knife's direction in lesion-up ESD can approach the muscular layer, increasing perforation risk.
• A rotating endoscope technique facilitates mucosal flap lifting and dissection plane approach, potentially preventing perforation.

Purpose of the Study:

• To compare the safety and efficacy of a rotating endoscope technique versus conventional lesion-up ESD.
• To assess short- and long-term outcomes of both ESD techniques.
• To evaluate the impact of the rotating technique on tumor characteristics like shape, location, and size.

Main Methods:

• Retrospective assessment of colorectal ESD procedures.
• Comparison of outcomes between a rotating technique group (41 lesions) and a lesion-up group (37 lesions).
• Analysis of dissection speed, R0 resection rates, perioperative complications, and recurrence rates.

Main Results:

• The rotating technique group showed significantly faster dissection speed (p=0.023).
• Higher R0 resection rates (p=0.008) and recurrence-free rates (p=0.018) were observed in the rotating technique group.
• The lesion-up group had significantly higher rates of perioperative complications (p=0.003) and local recurrence (p=0.001).

Conclusions:

• Endoscope rotating is a valuable technique for difficult colorectal ESD, improving access to the dissection plane.
• This technique enhances en bloc and R0 resection rates, irrespective of tumor size, shape, or location.
• The rotating method increases dissection speed without raising adverse event incidence.