Efficacy of novel modified double-scope ESD technique for large rectal lesion: video demonstration

The effectiveness of traction devices during endoscopic submucosal dissection (ESD) is limited for lesions near the anus due to the confined space. Although double-scope ESD (dsESD), an effective traction method for gastric lesions, could be beneficial, its application in this region is hindered by severe frictional interference between the two scopes and the tight anal passage, which restricts maneuverability. To address this, we developed a modified dsESD technique using a newly developed thin therapeutic endoscope (EG-840TP; Fujifilm, Tokyo, Japan; 7.9 mm in outer diameter, 3.2-mm working channel) as the main scope and an ultrathin endoscope (EG-840N; Fujifilm; 5.8 mm in outer diameter) as the assistant scope. By utilizing thin scopes for both roles, frictional interference is minimized, allowing greater maneuverability in the confined anorectal space. The accompanying video demonstrates the effectiveness of this method for an 80-mm rectal lesion. Despite the large size, ESD was completed in just 70 minutes without significant adverse events. The assistant scope provided precise traction using grasping forceps, allowing controlled mucosal tension in any direction. Horizontal traction allowed easy mucosal incision even without sufficient tension, and vertical elevation of the resected section facilitated hemostatic procedures with clear visualization. In addition, haustral folds that obstructed the procedure could be readily compressed using the assistant scope. This modified dsESD technique could be a practical option for large rectal lesions.