Snare Tip is an Alternative Tool for Colorectal Endoscopic Submucosal Dissection.

BACKGROUND Colorectal endoscopic submucosal dissection is typically performed by specialized knife, such as dual knife. However, it is not covered by Taiwan's national health insurance. In the literature review, using traditional snare tip for endoscopic submucosal dissection has been reported for stomach lesions only. OBJECTIVE The purpose of this study was to evaluate the outcomes of colorectal endoscopic submucosal dissection using snare tip. DESIGN We retrospectively reviewed the clinical using of snare tip compared with dual knife for colorectal endoscopic submucosal dissection. Postoperative short- and long-term outcomes were investigated after the procedure. SETTINGS This study was conducted at a single tertiary care institution. PATIENTS Patients who could not afford the expense of specialized knife were included. MAIN OUTCOME MEASURES Dissection time, dissection speed and perioperative complications were used for short-term outcome measurement. Recurrence-free rate was used for long-term outcome measurement. RESULTS Twenty-one lesions were in snare tip group and 57 lesions in dual knife group. The outcomes including rate of en-bloc resection, complication, local recurrence and recurrence-free interval between two groups were similar. The mean resected specimen diameter in dual knife group is larger than snare-tip group (p=0.041). The dissection time of snare tip group was shorter than dual knife group (p=0.025). However, the dissection speed was significantly slower in snare tip group than in dual knife group (p=0.008). LIMITATIONS This study was a retrospective and single doctor chart review in nature with limited patient number. CONCLUSIONS Snare tip is an alternative tool for colorectal endoscopic submucosal dissection in selected population without the support of specialized knives, such as dual knife. Although the dissection speed is slower using snare tip, it is still a recommended technique for developing country or low-income patients.

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