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Endoscopic submucosal dissection of a laterally spreading tumor in the right colon with a gastroscope after shortening the colon using a new double-balloon platform

Endoscopic submucosal dissection (ESD) allows en bloc resection of large superficial lesions in the gastrointestinal tract. Although ESD is frequently used in the rectum, esophagus, and stomach, it is only performed in the colon by high-volume experts, owing to the difficulty resecting lesions in this location. This location is technically challenging due to bowel movements, poor scope maneuverability due to loops, and thinness of the submucosal space and the muscular layer. Poor scope maneuverability is one of the most important risk factors for failure of colonic ESD and colon perforation.

Fuccio L, Ponchon T. Colorectal endoscopic submucosal dissection (ESD). Best Pract Res Clin Gastroenterol 2017; 31: 473-480

Sharma SK, Hiratsuka T, Hara H. et al. Antigravity ESD – double-balloon-assisted underwater with traction hybrid technique. Endosc Int Open 2018; 6: E739-E744

Sharma S, Momose K, Hara H. et al. Facilitating endoscopic submucosal dissection: double balloon endolumenal platform significantly improves dissection time compared with conventional technique (with video). Surg Endosc 2019; 33: 315-321