Fixation of an esophageal stent using a novel re-openable endoclip for a tracheoesophageal fistula.

Although esophageal stenting is one treatment option as a palliative treatment for tracheoesophageal fistulas, serious complications are associated with stent migration. Some reports have described stent fixation using various devices to prevent stent migration. However, these have yet to be sufficiently examined. We performed esophageal stent fixation using the MANTIS Clip (Boston Scientific), a novel re-openable endoclip. An 89-year-old man developed a tracheoesophageal fistula after radiotherapy for esophageal squamous cell carcinoma. Esophageal stenting was considered because the patient had difficulty with oral intake. However, the patient had a mild stenosis, which suggested stent migration. Therefore, we performed esophageal stent fixation by grasping the mouth side of the stent and the normal mucosa of the esophagus with the MANTIS Clip after placement of the stent. The esophageal stent closed the fistula, and the patient was able to take food orally. Upper gastrointestinal endoscopy performed 3 weeks after stenting showed residual MANTIS Clip and no evidence of stent migration. Esophageal stent fixation with MANTIS clips for tracheoesophageal fistulas may be an option to prevent stent migration.

Endoclip combined with colonic transendoscopic enteral tubing: a new approach for managing iatrogenic colonoscopy perforation.

BACKGROUND: Iatrogenic colonoscopy perforation (ICP) is a rare but most serious complication during colonoscopy investigation. However, endoscopic closure plays an important role in the dealing with ICP with the development of endoscopic techniques presently, there are still some portion of patients transferred to surgery. METHODS: Once a perforation was detected, endoclips were used to closed the defect of the colon. Then a colonic TET was planted inside the colon. The terminal end of the TET was put proximally to or near the location of the perforation. Then gas and fluid was sucked out through the TET with a syringe every 4 h. RESULTS: Three cases were treated with endoclip closure and colonic TET drainage. Case 1 was caused by urgent immediate perforation during routine colonoscopy, case 2 was delayed perforation after snare resection, and case 3 was ESD-related perforation. All patients got healed, no one transferred to surgery. CONCLUSIONS: A combination of endoclip closure and colonic TET drainage might be an easy and potential method in the dealing with different types of ICP. This study may offer a novel paradigm for addressing endoscopy-related intestinal perforations.

Migrated Laparoscopic Surgical Clips Causing Acute Cholangitis 32 Years After Laparoscopic Cholecystectomy.

Surgical clip migration post-laparoscopic cholecystectomy is a rare but important complication to consider in patients presenting with biliary obstruction. Titanium surgical clips are widely used in laparoscopic surgery to ligate vessels and ducts and are particularly important in laparoscopic cholecystectomy to ligate the cystic duct. More common complications associated with clips involve dislodgement, however, there are reported cases of migration into visceral structures causing an obstruction. We describe a case that demonstrated an acute migration of surgical clips into the common bile duct (CBD) within a three-week period, which occurred 32 years after laparoscopic cholecystectomy, likely attributed to erosion. On the patient's first presentation, she had acute pancreatitis with a CT demonstrating clips in the correct position. Three weeks later, the patient presented a second time with acute cholangitis and the repeat CT demonstrated the clips in the CBD. We hypothesize that the erosion of the bile duct is due to the pressure effects from either intra-abdominal organ movements or subtle clip movements, and eventually, persistent erosion leading to intra-ductal migration of the clips with the passage of the clips along the path of least resistance into the CBD, resulting in biliary obstruction. Management included standard treatment for biliary obstruction with intravenous broad-spectrum antibiotics and endoscopic retrograde cholangiopancreatography with excellent outcomes.

Hemoclip migration after revision carpal tunnel release: a case report.

A 22-year-old female presented to our clinic with the redevelopment of compressive symptoms after undergoing right carpal tunnel release 2 years prior. During revision surgery, the application of a chitosan polysaccharide membrane wrap over the median nerve was secured with three hemoclips. Follow-up revealed that these clips traveled distally to the volar aspect of the patient's small finger necessitating excision. Hemoclips in hand surgery serve as a useful tool for securing constructs; however, the recommendation to use them sparingly is made because of the potential for migration and exacerbation of symptoms.

Endoclip papillaplasty (ECPP) versus limited EST plus EPLBD for a decrease in recurrent choledocholithiasis: a prospective cohort study.

BACKGROUND AND AIMS: Limited EST plus EPLBD has been widely used for the therapy of large CBDS; however, long-term complication-relevant studies suggested that it damaged the function of the sphincter of Oddi (SO) and resulted in recurrent choledocholithiasis. Thus, we designed Endoclip papillaplasty (ECPP) and previous studies have shown that it successfully restored the function of SO. In this study, we designed a prospective cohort and aimed to verify the safety and effectiveness of ECPP. METHODS: Eligible patients were divided into the ECPP group and the limited EST plus EPLBD group based on papillary morphology and the ratio of maximum size of stones to length of intramural segments of CBD. All participants in the ECPP group received endoscopy at 3 weeks to retrieve the biliary stent, perform SOM, and were divided into grade A and grade B based on the healing grade of SO. All patients were followed up every 6 months until recurrent choledocholithiasis, patient death, or at the 36-month follow-up end. The primary outcome was the incidence of recurrent choledocholithiasis. The secondary outcomes included mechanical lithotrip usage and adverse events. RESULTS: The incidences of recurrent choledocholithiasis in the ECPP group and limited EST plus EPLBD group were 13.6 and 22.1%, respectively (P = 0.204). The ECPP-A group had a lower incidence of recurrent choledocholithiasis than the limited EST plus EPLBD groups (5.1 vs. 22.1%, P = 0.020*), and certified the function of SO successfully restored in the ECPP-A group. CONCLUSION: The ECPP-A group had a decrease in recurrent choledocholithiasis, and ECPP was safe and effective for CBDS.

Appendiceal stump closure in laparoscopic appendectomy: one endoloop vs. two endoloops vs. two endoclips-does it matter?

PURPOSE: Appendiceal stump leak rate after laparoscopic appendectomy is extremely low. Various methods are used to close the appendiceal stump. This study aimed to compare the outcome of three appendiceal stump closure methods. METHODS: A retrospective study comparing stump closure methods and postoperative outcomes was conducted from January 2018 to June 2020. Patient data included demographics, pre-operative data, surgical technique, findings, and postoperative complications. RESULTS: Out of 1021 appendectomy patients, 733 underwent laparoscopic appendectomy for acute appendicitis utilizing one of the three compared appendiceal stump closure methods. Consequently, 360 appendixes were ligated with one endoloop (1EL group), 300 appendixes had two endoloops (2EL group), and 73 appendixes were ligated with two endoclips (2EC group). All groups used a LigaSure for resection. The rate of postoperative intra-abdominal abscess was 1% (4 patients) in 1EL group vs. 1% (3 patients) in 2EL group vs. none in 2EC group (p = 0.43). There were no reported appendiceal stump leaks. Overall complication rates were 4% (14 patients), 3% (9 patients), and 0 (p = 0.15), and the mean operative length was 43 ± 21, 54 ± 22, and 43 ± 20 mins for the 1EL, 2EL, and 2EC, respectively (p < 0.01). Average cost of one endoloop is 110$, and one endoclip cartridge is 180$. CONCLUSIONS: None of the methods were found clinically superior over the others. Considering the low and mild complication rate, it appears reasonable to prefer one method simply by cost. The use of a single endoloop may result in substantial cost reduction. Medical centers may advise surgeons to use a single-endoloop technique.

Endoscopic management of low output recurrent colonic fistula or leak after anterior resection for rectal cancer: a randomized controlled trial.

BACKGROUND: Colonic anastomotic leak and fistula following anterior resection surgery for rectal cancer are associated with high mortality rates. The incidence of occurrence varies from 2 to 25% and it is difficult to accurately calculate the incidence of fistula and leak post anterior resection, as most of them are asymptomatic. Endoscopic management of fistula and leak has become the first line of management after conservative management in many gastrointestinal surgical centers with the advantages of being less invasive, shorter length of post-operative hospital stay, effective and rapid recovery in comparison to revision surgery. Effective endoscopic management for colonic fistula or leak depends on the clinical status of the patient and fistula characters (time-to-occur and size and site of defect), and device availability. METHODS: This prospective randomized controlled clinical trial included all patients who developed the manifestations of low output recurrent colonic fistula or leak after colonic anterior resection for rectal cancer at Zagazig University Hospital between (December 2020 and August 2022). Sample size was 78 patients divided into two equal groups. Endoscopic group (EG): included 39 patients who underwent endoscopic management. Surgical group (SG): included 39 patients who underwent surgical management. RESULTS: The investigators randomized eligible 78 patients into two groups: 39 patients in SG and 39 patients in EG. The median size of the fistula or leak was nine (range: 7-14) mm in EG, versus ten (range: 7-12) mm in SG. Clipping and Endo-stitch device were used in 24 patients versus 15 patients, respectively, in EG while primary repair with ileostomy, and resection & anastomosis were used in 15 patients versus 24 patients, respectively, in SG. Recurrence, abdominal collection, and mortality were the post procedure's complications with incidence of occurrence of 10.3, 7.7 and 0%, respectively, in EG versus 20.5, 20.5 and 2.6%, respectively, in SG. Excellent, good, and poor were the parameters for quality of life with incidence of occurrence of 43.6, 54.6 and 0%, respectively, in EG versus 28.2, 33.3 and 38.5%, respectively, in SG. Median hospital stay was one (range: 1-2) day in endoscopic group, and seven (range: 6-8) days in SG. CONCLUSION: Endoscopic intervention may offer a successful modality in managing low output recurrent colonic fistula or leak after anterior resection for rectal cancer that did not respond to conservative measures in stable patients. CLINICALTRIALS: gov ID: NCT05659446.

Application of endoscopic purse-string sutures in high-risk peptic ulcer hemorrhage: preliminary experience of 38 cases.

OBJECTIVE: This study is a prospective study to explore the therapeutic effect of endoscopic purse-string sutures in high-risk peptic ulcer hemorrhage. PATIENTS AND METHODS: We prospectively collected and analyzed data from July 2018 to December 2020 from patients in Jinshan hospital, Fudan University, who underwent emergency endoscopy for acute severe high-risk non-variceal upper gastrointestinal hemorrhage (NVUGIB) and were treated with endoscopic purse-string sutures. RESULTS: We included 38 patients whose median age was 64 years (interquartile range: 57.2 - 71.2 years). All patients were high risk gastric ulcer larger than 1 cm, including Forrest Ia (n = 4, 10.5%), Forrest Ib (n = 13, 34.2%) and Forrest IIa (n = 21, 55.3%). All patients were treated with endoscopic purse-string sutures. The clinical success rate reached 89.5%. Three patients suffered from rebleeding within seven days, and were treated with surgery or arterial embolization, respectively, all of which successfully stopped bleeding. One patient died of myocardial infarction. All other patients were followed up for 30 days without bleeding. CONCLUSIONS: We conclude that endoscopic purse-string sutures seem to be safe and effective in the treatment of patients at high risk of ulcer bleeding.

Duodenal Adenocarcinoma Versus Foreign Body Granuloma in the Background of Postcholecystectomy Migration of Endoclip Into Duodenum: A Histopathological Surprise.

A surgical endoclip in the cystic pedicle rarely migrates to the duodenum and is considered a rare complication of laparoscopic cholecystectomy. Duodenal adenocarcinoma endoscopically mimicking a foreign body granuloma in the background of postcholecystectomy endoclip migration has never been reported before. A 53-year-old Indian male presented with progressive weakness and melena for the last three months. He underwent laparoscopic cholecystectomy a year ago with an uneventful clinical course and post-operative recovery. A complete hemogram revealed hemoglobin of 4.5g/dL. Upper gastrointestinal endoscopy revealed a large necrotic polypoidal mass arising from the lateral wall of the first part of the duodenum. Contrast-enhanced computed tomography (CT) of the abdomen showed an impacted surgical clip into the lateral wall of the first part of the duodenum. Intraluminal extension of the surgical clip was not appreciated in the imaging. We suspected the diagnosis to be foreign body granuloma in the duodenal wall. He underwent open duodenal wedge resection. Microscopic evaluation of resected specimens revealed poorly differentiated adenocarcinoma. All the resection margins were free. He had an uneventful recovery and was discharged on the seventh post-op day. He was symptom-free and doing well on follow-up at 12 months. The purpose of reporting the case was to make the readers aware of the delayed massive upper gastrointestinal hemorrhage as a rare complication of endoclip migration (ECM) post laparoscopic cholecystectomy. In our case, the duodenal adenocarcinoma mimicked a foreign body granuloma endoscopically, and hence a possibility of duodenal adenocarcinoma as a potential delayed complication of ECM cannot be ruled out. Although rare, in case of upper gastrointestinal hemorrhage in the background of the previous history of laparoscopic cholecystectomy, endoclip migration should be kept as a differential diagnosis.

Endoclip migration after laparoscopic splenectomy combined with pericardial devascularization: Case report and literature review.

INTRODUCTION AND IMPORTANCE: Endoclip migration(ECM) after laparoscopic splenectomy combined with pericardial devascularization (LESD) is a rare and dangerous postoperative complication. The emergence of such cases led to our consideration of the timing of use of nonabsorbable endoclips. CASE PRESENTATION: This case report describes a patient with cirrhosis and portal hypertension who underwent LESD. Two years after the operation, an endoclip was found in the fornix of the fundus of his stomach by gastroscopy. CLINICAL DISCUSSION: A 66-year-old male patient had a history of liver cirrhosis for 9 years. Two years prior, LESD was performed on this patient in our hospital. This time, due to 'repeated black stool for 1 month, and hematemesis 1 time', the patient was admitted to the hospital. A diagnosis of 'liver cirrhosis with esophageal and gastric variceal bleeding' was considered. Gastroscopy revealed a fundal foreign body, and upon review of the patient history, the foreign body was found to be a nonabsorbable endoclip. CONCLUSION: Foreign literature has reported cases of biliary endoclip migration after laparoscopic cholecystectomy, but no cases of ECM after LESD have been reported. For such cases, we should consider the timing of the application of nonabsorbable endoclips during vascular devascularization to avoid ECM after the operation. In addition, we should also comprehensively evaluate whether the ectopic endoclips should be removed.

Safety and effectiveness of mucosal traction using a snare combined with endoclips to assist the resection of esophageal intraepithelial neoplasia: a propensity score matching analysis.

Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20-100 min); nontraction group, 70.0 min (range, 35-133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.

Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis.

BACKGROUND: Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. METHODS: This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. RESULTS: A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). CONCLUSIONS: ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.

Endoclip papillaplasty restores sphincter of Oddi function: Pilot study.

OBJECTIVES: Endoscopic sphincterotomy (EST) damaged the sphincter of Oddi (SO) function. This study aimed to explore the feasibility and efficacy of endoclip papillaplasty in restoring SO function. METHODS: This prospective pilot study included consecutive patients with choledocholithiasis (stone size ≥10 mm) who underwent large-EST for stone removal, followed by endoclip papillaplasty, between May 2018 and March 2019. RESULTS: Thirty patients were enrolled in this trail. Overall, 80% of the patients had a SO basal pressure of >10 mmHg after endoclip papillaplasty. Manometric parameters, including SO basal pressure, phasic wave contraction amplitude, phasic waves per minute, recovered after endoclip papillaplasty (P > 0.05). There were no significant differences in the manometric parameters of SO between healing grades A and B. Six patients developed mild post-endoscopic retrograde cholangiopancreatography pancreatitis, including three that had pancreatic stenting. Bile duct stone recurrence developed in 3.3% of the patients (1/30) during an 18-month follow-up. CONCLUSIONS: Endoclip papillaplasty might restore SO function and possibly prevented biliary stone and cholangitis recurrence.

Endoscopic endoclip papilloplasty preserves sphincter of oddi function.

BACKGROUND: Endoscopic sphincterotomy (EST) can destroy sphincter of Oddi (SO) structure and function. The purpose of this study was to assess the feasibility of endoscopic endoclip papilloplasty (EEPP) in restoring SO function after EST. METHODS: Seven 26-week-old domestic pigs were divided into control and EEPP groups. Necropsy and haematoxylin-eosin staining plus anti-α-smooth muscle actin (α-SMA) staining of papilla and sphincter of Oddi manometry (SOM) were conducted in animals at three independent time points. RESULTS: EST and EEPP were safely performed in all 7 pigs without serious adverse events. For primary outcome, compared to the controls, EEPP generated smaller dilation and less inflammation. Fibrous repair of the papilla was observed at 24 weeks after EEPP. For secondary outcome, in the control group, SO basal pressure (17.25 ± 18.14 to 5.50 ± 0.71 mmHg), SO contraction amplitude (46.00 ± 19.20 to 34.50 ± 48.79 mmHg), peak (4.50 ± 4.04 to 1.50 ± 2.12) and frequency (3.05 ± 3.29 to 1.41 ± 2.19/min) were reduced after EST. Further reductions to almost 0 of these SOM parameters were observed 3 weeks later, including common bile duct pressure and SO contraction period. In contrast, in the EEPP group, these manometric data were recovered to pre-EST levels, including CBD pressure (11.5 ± 7.31 vs 11 ± 2.16 mmHg), SO pressure (17.50 ± 17.75 vs 18.20 ± 21.39 mmHg) and SO contraction amplitude (53.67 ± 21.54 vs 60.00 ± 36.08 mmHg). However, no significant differences were observed between control and EEPP groups by Student t test. CONCLUSIONS: In this porcine study, EEPP accelerated and improved papillary healing after EST, further preserved SO function.

Endoscopic clipping for gastrointestinal bleeding: emergency and prophylactic indications.

Endoscopic clipping has become a common practice among endoscopists. Several models are available, most frequently being introduced via the working channel of the endoscope (through-the-scope); however, larger clips can also be mounted onto the distal tip of the endoscope (over-the-scope). The main indications for endoclip placement include providing effective mechanical hemostasis for bleeding lesions and allowing endoscopic closure of gastrointestinal perforations. Endoclips can also be used prophylactically after endoscopic resection; however, this practice is still controversial. This review discusses the main indications for endoscopic clipping in the esophagus, stomach, duodenum and colon to manage acute bleeding lesions, and the criteria to be used in the prevention of delayed post-polypectomy bleeding.

Late biliary endoclip migration after laparoscopic cholecystectomy: Case report and literature review.

INTRODUCTION: Although formerly considered a rarity, biliary endoclip-related complications are being diagnosed with increasing frequencies. Among these, migration of endoclip into the common bile duct (CBD) is a rare encounter that usually presents in the first two years after surgery. PRESENTATION OF CASE: This case demonstrates a late biliary endoclip migration after laparoscopic cholecystectomy. DISCUSSION: An 82-year-old male patient, with a history of laparoscopic cholecystectomy 22 years ago, presented with two-day history of severe upper abdominal pain. Routine hemogram and serum chemistry were remarkable for slightly raised alanine aminotransferase and C-reactive protein. A computed tomographic (CT) scan demonstrated a new metallic density within the CBD when compared to a previous CT scan 14 months earlier. An endoscopic retrograde cholangiography confirmed a metal endoclip within the mid-CBD contained within a choledochal stone. Balloon extraction of the endoclip and stone was successfully performed. The patient was discharged 2 days later, and remained symptom free for 1 year. CONCLUSION: To our knowledge, a latency of 22 years between cholecystectomy and clip migration has never been reported before. In cases of post-cholecystectomy abdominal pain the awareness of the surgeon should always be drawn to a clinical suspicion of endoclip migration into the CBD that can be easily remedied. Endoscopic biliary sphincterotomy with endoclip/stone removal is the therapeutic procedure of choice which usually circumvents the need for surgical extraction.

Twin-Twin Transfusion Syndrome Complicated by Proximate Placental Cord Insertion Sites: Endoscopic Clip-Assisted Laser Occlusion.

INTRODUCTION: Severe twin-twin transfusion syndrome (TTTS) with a large vascular communication between proximate placental cord insertion sites is a therapeutic dilemma because laser ablation may cause thermal injury to the cord roots and subsequent fetal demise. CASE PRESENTATION: Stage IV TTTS with placental cord insertion sites 1.3 cm apart and with an intervening large arterio-arterial (AA) anastomosis presented for treatment. The application of endoclips onto the large AA anastomosis between the cord roots allowed for successful laser occlusion using minimal energy. Both the donor and recipient twins were alive and well at 6 months of age. CONCLUSION: Endoscopic clip-assisted laser occlusion of a placental vessel is technically feasible and may be a useful therapeutic option in select cases.

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection.

INTRODUCTION: The most commonly used treatment for advanced colorectal adenomas is endoscopic mucosal resection (EMR). The increased number of EMRs since the introduction of the screening program for colorectal cancer has resulted in an increase in EMR-related complications. This review summarizes the current knowledge for the use of clips for the treatment and prevention of complications after EMR. AREAS COVERED: The historical development of clips is summarized and their properties are evaluated. An overview is presented of the evidence for therapeutic and prophylactic clipping for bleeding or perforation after EMR in the colon. Several clipping techniques are discussed in relation to the efficacy of wound closure. Furthermore, new techniques that will likely influence the use of clips in the future endoscopic practice, such as endoscopic full-thickness resection (eFTR) are also highlighted. EXPERT COMMENTARY: Most research focuses on prophylactic clipping for delayed bleeding after EMR of large adenomas. We advocate a distance of 0.5-1.0 cm between aligning clips. This focus may likely shift from bleeding to perforation. Here, endoscopic treatment with through-the-scope clips and large-diameter clips may well replace surgery. The future role of clips will also depend on the further development of new endoscopic technologies, such as eFTR.

A snare combined with endoclips to assist in endoscopic submucosal dissection for intraepithelial neoplasia in the entire colon and rectum.

OBJECTIVE: The use of mucosal traction to assist in colonic and rectal endoscopic submucosal dissection (ESD), especially for deep colonic ESD, is challenging. We developed a method of inverse insertion of a snare into the endoscopic working channel to deliver it into the colon together with the endoscope. With this method, two types of mucosal traction, per-anal external traction (PET) and per-anal internal traction (PIT), could be achieved using a snare with endoclips to assist in ESD (ESD-SE). Here, we aimed to examine its safety and feasibility. METHODS: From January 2017 to September 2018, 50 colonic and rectal intraepithelial neoplasias in 50 patients were treated with ESD-SE. Data on lesion location and size, operation time, en bloc resection and R0 resection rates, and operative complications were collected. RESULTS: Among 50 lesions, 15 lesions were located in the deep colon/proximal colon, and 35 lesions were in the distal colon. The median (interquartile range) size of lesions, submucosal dissection time, and total operation time were 4.5 (3.0-5.0) cm, 32 (18-81) min, and 50 (33-108) min, respectively. All lesions were completely resected, with R0 resection rates of 100%. No intraoperative and postoperative complications occurred. Postoperative pathology revealed 40 and 10 cases of high-grade and low-grade intraepithelial neoplasia, respectively. CONCLUSIONS: The approach using insertion of a selective snare into the colon together with the endoscope, especially into the deep colon, was safe and simple. Use of the snare combined with endoclips could effectively assist in total colonic ESD. Further research is warranted.