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ENHANCED OUTCOMES WITH THE DILUMEN C1 ENDOSURGICAL PLATFORM FOR COLORECTAL LESION REMOVAL: A COMPREHENSIVE EVALUATION
Mustafa Oruc
*, Salih N. Karahan, Brogan Catalano, Joshua Sommovilla, Emre Gorgun
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Objective
Endoscopic submucosal dissection (ESD) is a minimally invasive technique for en bloc resection of large colorectal lesions, enabling precise histopathological evaluation and organ preservation. It is particularly valuable for high-grade dysplasia or early malignant lesions confined to the mucosa or superficial submucosa. By achieving R0 resection, ESD minimizes recurrence and eliminates the need for radical organ resection in selected cases. However, adoption in Western countries has been limited due to challenges such as traction, stability, and the steep learning curve. This study evaluates the clinical utility of the DiLumen C1 platform in addressing these challenges and facilitating effective resection of complex colorectal lesions.
Methods
This single-center retrospective study analyzed outcomes from 23 patients with 25 colorectal lesions treated using the DiLumen C1 platform between July 2023 and September 2024. The platform includes a single balloon on an endoscopic oversheath with an attached channel to pass a flexible grasper, providing stability and traction during dissection (DiLumen C1, Lumendi, LLC). Data included patient demographics, lesion characteristics, procedural outcomes, and reasons for conversion to standard ESD.
Results
The lesions were located in the ascending colon (n=6, 24%), hepatic flexure (n=3, 12%), transverse colon (n=3, 12%), splenic flexure (n=2, 8%), sigmoid colon (n=5, 20%), and rectum (n=6, 24%). Among 23 patients (mean age: 64.5 years; 4 female), the median lesion size was 50 mm (range: 40–70). All resected lesions achieved R0 resection except one adenocarcinoma, with no intraoperative or postoperative complications. The median length of stay was 0 days, with 91.3% of patients discharged on the same day. Conversion to standard ESD occurred in 26% of cases due to challenges such as balloon fallback in flexures, visibility issues in redundant colons, or balloon interference. The median dissection time was 66 minutes (range: 48–120), with a time/lesion size ratio of 1.3 (range: 0.82–1.89).
Conclusion
ESD achieves en-bloc resection critical for oncological outcomes but is technically demanding due to single-handed dissection and lack of traction, especially in complex anatomical areas. The DiLumen C1 platform enhances traction, stability, and visualization, improving efficiency and potentially reducing procedural time. Despite limitations in flexures and redundant colons, it simplifies ESD and may shorten the learning curve for practitioners.
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