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. 2021 Sep 28;2(1):e58.
doi: 10.1002/deo2.58. eCollection 2022 Apr.

Efficacy of single-balloon overtube for endoscopic submucosal dissection in the proximal colon: A propensity score-matched analysis

Hidenori Tanaka  1 , Shiro Oka  2 , Akiyoshi Tsuboi  1 , Yuki Kamigaichi  2 , Hirosato Tamari  2 , Akihiko Sumioka  2 , Yasutsugu Shimohara  2 , Tomoyuki Nishimura  2 , Katsuaki Inagaki  2 , Yuki Okamoto  2 , Sumio Iio  2 , Ken Yamashita  1 , Kyoku Sumimoto  1 , Shinji Tanaka  1
Affiliations

Efficacy of single-balloon overtube for endoscopic submucosal dissection in the proximal colon: A propensity score-matched analysis

Hidenori Tanaka et al. DEN Open. .

Abstract

Objectives: A single-balloon overtube (SBO) can improve poor scope operability during colonic endoscopic submucosal dissection (ESD). We aimed to evaluate the clinical usefulness of SBO for ESD in the proximal colon and the predictive factors for cases in which SBO is useful.

Methods: A total of 88 tumors located in the proximal colon resected by balloon-assisted ESD (BA-ESD) using SBO and 461 tumors resected by conventional ESD (C-ESD) between June 2015 and November 2020 were considered. Seventy-eight tumors each in the BA-ESD and C-ESD groups were matched by propensity score matching. ESD outcomes were compared between the groups, and a decision tree analysis was performed to explore the predictive factors for cases in which SBO is useful.

Results: There were no significant differences between the groups in the major outcomes such as en bloc resection rate (95% vs. 99%, p = 0.17), R0 resection rate (92% vs. 96%, p = 0.30), mean dissection speed (16 mm2/min vs. 16 mm2/min, p = 0.53), and intraoperative perforation rate (5% vs. 6%, p = 0.73). Even when considering cases with poor preoperative scope operability, there were no significant differences between the groups. Comparison of tumors ≥40 mm in diameter between the groups confirmed that the intraoperative perforation rate was significantly lower in the BA-ESD group than in the C-ESD group (0% vs. 24%, p = 0.0188).

Conclusion: SBO is useful for ESD of tumors ≥40 mm in diameter in the proximal colon to prevent intraoperative perforation, which usually has a long procedure time.

Keywords: colorectal ESD; perforation; proximal colon; scope operability; single‐balloon overtube.

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Conflict of interest statement

The authors declare no conflict of interest for this article.

Figures

FIGURE 1
FIGURE 1
Flowchart of patient enrollment. ESD, endoscopic submucosal dissection; BA‐ESD, balloon‐assisted ESD; C‐ESD, conventional ESD; BMI, body mass index
FIGURE 2
FIGURE 2
Changes in scope operability in cases with poor preoperative scope operability. Poor scope operability improved significantly in BA‐ESD cases compared with that in C‐ESD cases (36% vs. 13%, p < 0.0001). However, it was still poor in 63% of the cases despite SBO use. ESD, endoscopic submucosal dissection; BA‐ESD, balloon‐assisted ESD; C‐ESD, conventional ESD; SBO, single‐balloon overtube
FIGURE 3
FIGURE 3
Decision tree analysis for preventing intraoperative perforation. Regarding tumors ≥40 mm in diameter, intraoperative perforation rates are 0.21% in BA‐ESD cases and 14.55% in C‐ESD cases. ESD, endoscopic submucosal dissection; BA‐ESD, balloon‐assisted ESD; C‐ESD, conventional ESD
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