Post written by Yuzuru Tamaru, MD, PhD, from the Department of Gastroenterology, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, Kure, Japan.

In this report, we present 2 cases of precutting endoscopic mucosal resection (EMR)/hybrid endoscopic submucosal dissection (ESD) with a circumferential incision and partial dissection followed by snare resection via SOUTEN. We also discuss the use of SOUTEN for colorectal ESD of sessile serrated polyps (SSPs).

A novel multifunctional snare (MFS) (SOUTEN; Kaneka Medics, Tokyo, Japan) was introduced to allow for an easy and time-efficient hybrid ESD. The MFS combines an 18.5-mm snare loop with a 1.5-mm needle-knife and a knob-shaped tip attached to the top of the snare loop. This snare is advantageous because the knob-shaped tip allows the needle-knife to stabilize and place tension on the resected surface during circumferential incision and/or partial submucosal dissection, and all of the procedures can be completed using a single device. If the submucosal layer can be visualized properly after the submucosal dissection, we can leave the submucosal dissection as is. On the other hand, in cases where the submucosal layer is poorly visualized, we can switch from the submucosal dissection to the snare resection with only this one device. Furthermore, it is cheaper than other ESD knife devices.

One of the problems associated with the colorectal ESD is fibrosis in the submucosal layer during ESD. Fibrosis increases the risk of perforations and is one of the factors that can prolong the procedure time. Therefore, we must also be careful when using the MFS in cases with fibrosis. On the other hand, we believe that most SSPs do not have fibrosis in the submucosal layer. Therefore, in most cases, we experience sufficient submucosal swelling after the injection for the submucosal layer, and SSPs in particular would be a good indicator in colorectal tumors for precutting EMR/hybrid ESD using the MFS.

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