Post written by Ciaran Judge, MD, MB, BCh, BAO, and Niroshan Muwanwella, MD, from the Royal Perth Hospital, Perth, Western Australia, Australia.

Endoscopic submucosal dissection (ESD) is an important tool for resection of colorectal lesions with features suggestive of superficial submucosal invasion. However, resection of proximal lesions can be challenging for several reasons.

We present the case of a 68-year-old man with a 4 x 3-cm polyp in the ascending colon detected after a positive fecal immunochemical test result as part of the Bowel Cancer Screening Program. On endoscopic assessment with narrow-band imaging and magnification, the lesion was predominantly JNET 2A, with a focus of 2B on the oral side. Given the potential risk of submucosal invasion, the decision was made to proceed with ESD.

Traction was required during the procedure to optimize view of the submucosal plane. We demonstrate the creation of a novel, easy-to-use, cheap, and effective method of multipoint traction called Star-Loop. Our video illustrates how to create Star-Loop and pass it through the working channel using a clip. The device is attached to the contralateral wall from the lesion, and further clips can then be used to create multiple directions of traction as required.

Our video highlights the enhanced visibility of the submucosal plane after attachment of Star-Loop, which enabled efficient and safe resection. The lesion was successfully dissected and removed en bloc, with histopathology confirming R0 resection of a tubulovillous adenoma with low-grade dysplasia.

We believe this video features the potential to create useful, effective, and economical methods of traction to enhance ESD practice that can be widely adopted without significant financial duress. We also feel that this is a useful and practical demonstration of multipoint traction within the colon that benefits from maximizing available space and functionality.

We hope that other units consider the use of Star-Loop as a form of multipoint traction for colonic ESD and that endoscopists may be encouraged to develop their own methods of enhancing their practice to advance the field and ensure we provide top-quality care for our patients.

Ascending colon polyp. Endoscopic image of the ascending colon lesion before resection.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.