Post written by Jun Arimoto, MD, PhD, from the Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan.

A novel multifunctional snare (SOUTEN; Kaneka Medics, Tokyo, Japan) was introduced to enable successful hybrid ESD procedures. Although this multifunctional snare was introduced for hybrid ESD, hybrid ESD involves partial submucosal dissection, and we have previously reported the safety and efficacy of ESD using this multifunctional snare. The working length of the knife can be adjusted, and this is one of the advantages of ESD using this multifunctional snare. By adjusting the working length of the knife to be longer than usual, the area that can be dissected at once is expanded. Dissection can safely proceed at a faster rate. Therefore, we developed the new technique of “free style ESD” using the multifunctional snare. An 84-year-old man had a 45-mm neoplasm in the greater curvature of the lower gastric body. The working length of the knife is adjustable depending on the situation. We basically used only the tip of the knife for dissection during ESD procedure, and we sometimes used the snare part for dissection by adjusting the working length of the knife to be longer. The lesion was resected en bloc within 26 min without any adverse events. Histological examination revealed an adenocarcinoma (tub 1, pT1a(M), ly0, v0, pHM0, pVM0) and curative resection. We performed ESD for a 45-mm neoplasm in this study, and it is desirable that indications for whether to perform hybrid ESD or ESD using this multifunctional snare for gastric neoplasms are investigated in the future. This is the first report of “freestyle ESD” using the multifunctional snare.

The working length of the knife is adjustable depending on the situation. By adjusting the working length of the knife according to the situation, this multifunctional snare achieved a good balance between safety and efficiency.

We have reported the safety of colorectal ESD using this multifunctional snare. Although colorectal ESD is technically difficult and careful judgement is required, there is the possibility that “freestyle ESD” can be performed for colorectal neoplasms in the future.

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