Usefulness of a second endoscopic arm to improve therapeutic endoscopy in the lower gastrointestinal tract. Preliminary experience - a case series

Endoscopic submucosal dissection is a difficult procedure with frequent complications. Our aim was to test the feasibility of utilizing a second endoscopic arm to improve the dissection. An Olympus prototype blind probe, with an external diameter of 6 mm and a 2.8-mm working channel, was used as a second endoscopic arm. Its purpose was to lift the lesion during dissection. The main endoscope served both to perform the dissection and to visualize the second endoscopic arm in the monitor. Eight patients with polypoid lesions in the rectum or distal sigmoid were treated successfully. The procedure was feasible, and submucosal exposure was ameliorated allowing easier dissection. The resection was curative in all cases. No recurrences have been detected during up to 18-months of follow-up. A small perforation and two cases of delayed bleeding were managed nonsurgically. Applying counter-traction with a second endoscopic arm can facilitate submucosal dissection of distal colorectal lesions.