Self-assembled hydro-jet system for submucosal elevation before endoscopic resection of nonpolypoid colorectal lesions

Background: Endoscopic resection of colorectal nonpolypoid lesions requires adequate submucosal lifting of the lesion. Objective: To evaluate a self-assembled hydro-jet system for tissue elevation to improve endoscopic resection of colorectal nonpolypoid lesions. Design: Prospective study. Setting: Single-center teaching hospital. Main Outcome Measurements: Efficacy and safety of the hydro-jet system and rate of complete resection. Results: The system was clinically applied in 31 patients to remove a total of 34 lesions throughout the colon. An adequate Submucosal fluid cushion was achieved in all but 1 case without any lifting-associated complications. Complete endoscopic resection was possible in all 33 lifted lesions by using a snare. The size of the resected lesions ranged from 7 to 60 mm. Major intraprocedure bleeding occurred in only I case. No perforation or late bleeding was recorded. Histological examination showed a selective accumulation of fluid in the submucosa with edema and dissociation of submucosal structures, with no damage to the muscularis mucosa and very limited "burn effect" hampering assessment of radial margins. Limitations: Lack of controls. Conclusions: This inexpensive system allows safe and rapid submucosal lifting of colorectal nonpolypoid lesions to assist endoscopic resection.