Background: Endoscopic Submucosal Dissection (ESD) is a highly effective technique for removing large and complex colon lesions. It offers improved rates of en-bloc resection and reduced local recurrence. Challenges in achieving adequate traction-countertraction contribute to the technical complexity and time-consuming nature of ESD. We share our initial experiences using a second-generation platform designed to enhance endoluminal surgery.
Impact of Innovation: The development of an endoluminal device promises to enhance the precision and effectiveness of colorectal lesion removal. It aims to provide easier access to the target site, reduce the procedure's duration, and lower the risk of complications.
Technology Materials and Methods: The platform consists of a single balloon on an endoscopic oversheath with an attached channel to pass a flexible grasper to provide stability and traction during dissection (DiLumen C¹, Lumendi, LLC). This single-center feasibility study, conducted between July 2023 and November 2023.
Preliminary Results: Seven patients with complex colorectal lesions underwent endoscopic submucosal dissection. The mean age of our patients was 66 years (±16.59), and all were male. Among them, 4 patients (58%) had lesions in the rectum, 1 (14%) in the transverse colon, 1 (14%) in the ascending colon and 1 (14%) in the sigmoid colon. The mean size of the lesions was 77mm (±49.06). All patients presented with laterally spreading tumors: 6 (86%) granular and 1 (14%) non-granular lesion. Three patients (43%) were diagnosed with tubular adenoma, 3 patients (43%) had tubulovillous adenoma, 1 patient (14%) had serrated adenoma, 6 patients (86%) had high-grade dysplasia, and 1 patient (14%) exhibited no dysplasia. All patients achieved en-bloc resection (Table 1). The average duration of the entire procedure was recorded at 136 minutes (±39), with the average dissection time being approximately 70 minutes (±13.14). Six of our patients (86%) were discharged on the same day, while one patient (14%) was discharged at the end of the first day, with no complications occurring during or after any of the procedures.
Conclusion: This early report supports the safety, functionality, and feasibility of a platform designed to facilitate precise en-bloc dissection of complex and large colorectal lesions.
Future Direction: The findings of this study require validation through further research involving larger sample sizes and extended follow-up periods.

Table 1: Cohort characteristics, demographics, and variables

Attila Ulkucu

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