Uploaded July 2017 | Updated September 2026, 9 hours ago
Endoscopic submucosal dissection (ESD) in the colon bears a significant risk of complications due to the fragility of the wall, reduced maneuverability of the endoscope and lack of countertraction. Lately, tunneling methods such as the pocket creation method and the single/multiple tunneling technique have been introduced in an effort to overcome these difficulties. Hereby we describe a single tunneling technique (SST) for the resection of a lateral spreading tumor (LST) of the transverse colon in a 47-year-old woman with inactive ulcerative colitis. We used the following materials: a 1.5 mm DualKnife and a CF185 coloscope (Olympus), a short hood (Fujifilm), CO2 insufflation and a mixture of hydroxyethyl starch (Voluven, Fresenius Kabi), hyaluronic acid 0.4% (Sigmavisc, Life Partners Europe) and indigocarmine for submucosal injection. The setting for dissection was Endocut Q, Effect 2 (ERBE VIO3, Tubingen, Germany). The procedure was undertaken under general anesthesia and lasted 2 hours. In short, a submucosal tunnel was created underneath the lesion with one proximal and one distal opening. Then, the dissection was expanded towards the lateral borders and finally the lesion was detached by cutting the lateral margins. This technique allowed a safe dissection of the specimen by a junior ESD-endoscopist due to: less dispersion of the submucosal fluid, constant traction and counter traction by pushing the specimen through the tunnel, convenient orientation of the dissection field, good visualization of the vessels, progression of dissection independently of the direction of gravity and good stability of the endoscope. The patient was hospitalized for 24 hours and had an uneventful recovery. Histology disclosed a 4 cm tubulo-villous adenoma with low grade dysplasia. In conclusion, SST may be used for safe and easier resection of LSTs. Further studies are needed to establish the various tunneling methods as an essential tool for safer colon-ESD.
You may watch more educational videos related to endoscopic submucosal dissection here:
Classification based on the demonstrated technique
• Tunneling technique for the colon: youtu.be/NHjPKPbcjoo?list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Pocket creation method for gastric submucosal lesions: youtube.com/watch?v=F9IybJBb-R4&index=7&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Pocket creation method in the stomach: youtube.com/watch?v=BYewXtzJhiM&index=8&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Step by Step ESD in the stomach youtube.com/watch?v=5huY0k9GocA&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW&index=2&t=809s and youtube.com/watch?v=PVmscXysW08&index=4&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Bleedings during ESD: youtube.com/watch?v=tJMp8Xu61fw&index=5&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Perforations during ESD: youtube.com/watch?v=BYewXtzJhiM&index=8&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Clip and snare technique: youtube.com/watch?v=ThNpoZsCiMc&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW&index=9
• ESD of condylomas: youtube.com/watch?v=My5EfJn3ego&index=11&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Use of ITKnife nano: youtube.com/watch?v=EKfcqHMBFAA&index=14&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Treatment of esophageal strictures with ESD: youtube.com/watch?v=YrQ39eVaNgA
Classification based on the location of the lesion
• ESD at the cecum: youtube.com/watch?v=THZXa_4EWwU and youtube.com/watch?v=EKfcqHMBFAA&t=37s
• ESD at the transverse colon: youtube.com/watch?v=NHjPKPbcjoo
• ESD near the ileocecal valve: youtube.com/edit?o=U&video_id=oxIJjN8gldw
• ESD at the rectum: youtube.com/watch?v=tJMp8Xu61fw&t=123s
• Gastric carcinoid youtube.com/watch?v=aVeptKx7ZZQ&t=2s and youtube.com/watch?v=BYewXtzJhiM&t=46s and youtube.com/watch?v=KcDxJHW2eKw&t=20s
• ESD of gastric lipomas: youtube.com/watch?v=F9IybJBb-R4&index=7&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• ESD of gastric fibroid inflammatory polyp: youtube.com/watch?v=Tzmu17UKksE
Endoscopic submucosal dissection (ESD) in the colon bears a significant risk of complications due to the fragility of the wall, reduced maneuverability of the endoscope and lack of countertraction. Lately, tunneling methods such as the pocket creation method and the single/multiple tunneling technique have been introduced in an effort to overcome these difficulties. Hereby we describe a single tunneling technique (SST) for the resection of a lateral spreading tumor (LST) of the transverse colon in a 47-year-old woman with inactive ulcerative colitis. We used the following materials: a 1.5 mm DualKnife and a CF185 coloscope (Olympus), a short hood (Fujifilm), CO2 insufflation and a mixture of hydroxyethyl starch (Voluven, Fresenius Kabi), hyaluronic acid 0.4% (Sigmavisc, Life Partners Europe) and indigocarmine for submucosal injection. The setting for dissection was Endocut Q, Effect 2 (ERBE VIO3, Tubingen, Germany). The procedure was undertaken under general anesthesia and lasted 2 hours. In short, a submucosal tunnel was created underneath the lesion with one proximal and one distal opening. Then, the dissection was expanded towards the lateral borders and finally the lesion was detached by cutting the lateral margins. This technique allowed a safe dissection of the specimen by a junior ESD-endoscopist due to: less dispersion of the submucosal fluid, constant traction and counter traction by pushing the specimen through the tunnel, convenient orientation of the dissection field, good visualization of the vessels, progression of dissection independently of the direction of gravity and good stability of the endoscope. The patient was hospitalized for 24 hours and had an uneventful recovery. Histology disclosed a 4 cm tubulo-villous adenoma with low grade dysplasia. In conclusion, SST may be used for safe and easier resection of LSTs. Further studies are needed to establish the various tunneling methods as an essential tool for safer colon-ESD.
You may watch more educational videos related to endoscopic submucosal dissection here:
Classification based on the demonstrated technique
• Tunneling technique for the colon: youtu.be/NHjPKPbcjoo?list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Pocket creation method for gastric submucosal lesions: youtube.com/watch?v=F9IybJBb-R4&index=7&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Pocket creation method in the stomach: youtube.com/watch?v=BYewXtzJhiM&index=8&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Step by Step ESD in the stomach youtube.com/watch?v=5huY0k9GocA&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW&index=2&t=809s and youtube.com/watch?v=PVmscXysW08&index=4&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Bleedings during ESD: youtube.com/watch?v=tJMp8Xu61fw&index=5&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Perforations during ESD: youtube.com/watch?v=BYewXtzJhiM&index=8&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Clip and snare technique: youtube.com/watch?v=ThNpoZsCiMc&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW&index=9
• ESD of condylomas: youtube.com/watch?v=My5EfJn3ego&index=11&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Use of ITKnife nano: youtube.com/watch?v=EKfcqHMBFAA&index=14&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• Treatment of esophageal strictures with ESD: youtube.com/watch?v=YrQ39eVaNgA
Classification based on the location of the lesion
• ESD at the cecum: youtube.com/watch?v=THZXa_4EWwU and youtube.com/watch?v=EKfcqHMBFAA&t=37s
• ESD at the transverse colon: youtube.com/watch?v=NHjPKPbcjoo
• ESD near the ileocecal valve: youtube.com/edit?o=U&video_id=oxIJjN8gldw
• ESD at the rectum: youtube.com/watch?v=tJMp8Xu61fw&t=123s
• Gastric carcinoid youtube.com/watch?v=aVeptKx7ZZQ&t=2s and youtube.com/watch?v=BYewXtzJhiM&t=46s and youtube.com/watch?v=KcDxJHW2eKw&t=20s
• ESD of gastric lipomas: youtube.com/watch?v=F9IybJBb-R4&index=7&list=PL_DeFO6lp5xLltO92l9FkuV9UhXyl3_QW
• ESD of gastric fibroid inflammatory polyp: youtube.com/watch?v=Tzmu17UKksE
