A new sinker-assisted endoscopic submucosal dissection for colorectal cancer

Background Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer, but it is not widely used to treat the colorectum because of its degree of technical difficulty. Thus, a noninvasive tool that facilitates the direct visualization of the submucosal layer is needed. Methods Traction-assisted dissection was performed on 4 superficial lesions. The system consisted of a metallic clip attached by a nylon line to a sinker 6 × 4 × 4 mm in size and weighing 1 g. After partially dissecting the submucosa, the clip was attached to the edge of the exfoliated mucosa and the weight of the sinker pulled down the partly resected lesion. Observations In all 4 cases, the sinker allowed direct visualization of the cutting line, and en bloc resection was successfully accomplished. Conclusions These preliminary results suggest that sinker-assisted ESD is effective for the complete removal of selected superficial early colorectal cancer.