Brief Article
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World J Gastroenterol. Sep 7, 2010; 16(33): 4180-4186
Published online Sep 7, 2010. doi: 10.3748/wjg.v16.i33.4180
Efficient hemostatic method for endoscopic submucosal dissection of colorectal tumors
Naohisa Yoshida, Yuji Naito, Munehiro Kugai, Ken Inoue, Naoki Wakabayashi, Nobuaki Yagi, Akio Yanagisawa, Toshikazu Yoshikawa
Naohisa Yoshida, Yuji Naito, Munehiro Kugai, Ken Inoue, Naoki Wakabayashi, Nobuaki Yagi, Toshikazu Yoshikawa, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto 602-8566, Japan
Akio Yanagisawa, Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto 602-8566, Japan
Author contributions: Yoshida N designed the study and performed the surgery, data collection, data analysis, manuscript preparation, and review; Naito Y arranged the study and performed the majority of the manuscript review; Kugai M, Inoue K, Wakabayashi N and Yagi N performed the surgery, manuscript preparation, and review; Yanagisawa A did the histopathological data analysis and reviewed the manuscript; Yoshikawa T was the mentor and prepared and reviewed the manuscript.
Correspondence to: Naohisa Yoshida, MD, PhD, Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. naohisa@koto.kpu-m.ac.jp
Telephone: +81-75-2515519 Fax: +81-75-2510710
Received: April 9, 2010
Revised: May 20, 2010
Accepted: May 27, 2010
Published online: September 7, 2010
Abstract

AIM: To evaluate a new hemostatic method using hemostatic forceps to prevent perforation and perioperative hemorrhage during colonic endoscopic submucosal dissection (ESD).

METHODS: We studied 250 cases, in which ESD for colorectal tumors was performed at the Kyoto Prefectural University of Medicine or Nara City Hospital between 2005 and 2010. We developed a new hemostatic method using hemostatic forceps in December 2008 for the efficient treatment of submucosal thick vessels. ESD was performed on 126 cases after adoption of the new method (the adopted group) and the new method was performed on 102 of these cases. ESD was performed on 124 cases before the adoption of the new method (the unadopted group). The details of the new method are as follows: firstly, a vessel was coagulated using the hemostatic forceps in the soft coagulation mode according to the standard procedure, and the coagulated vessel was removed using the forceps in the “endocut” mode without perioperative hemorrhage. Secondly, the partial surrounding submucosa was dissected using the forceps in the endocut mode. In the current study, we evaluated the efficacy of this method.

RESULTS: Coagulated vessels were successfully removed using the hemostatic forceps in all 102 cases without severe perioperative hemorrhage. Moderate perioperative hemorrhage occurred in five cases (4.9%); however, it was stopped by immediately reuse of the hemostatic forceps. The partial surrounding submucosa was dissected using the forceps in all 102 cases. In the adopted group, the median operation time was 105 min. The proportion of endoscopic en bloc resection was 92.8% (P < 0.01) compared to 80.6% in the unadopted group. The postoperative hemorrhage and perforation rates were 2.3% and 2.3%. The rate of perforation was significantly lower than that in the unadopted group (9.6%, P < 0.01). We evaluated the ease of use of this method by allowing our three trainees to performed ESD on 46 cases, which were accomplished without any severe hemorrhage.

CONCLUSION: The new method effectively treated submucosal thick vessels and shows promise for the prevention of perforation and perioperative hemorrhage in colonic ESD.

Keywords: Endoscopic submucosal dissection, Colorectal tumor, Hemostatic forceps, Perforation, Perioperative hemorrhage