# Set-up and use of the “Asclepius tube”: a slim drainage tube to facilitate saline-immersion endoscopic submucosal dissection

## TL;DR

A new drainage tube called the 'Asclepius tube' improves saline-immersion endoscopic submucosal dissection by maintaining fluid balance and enhancing patient comfort.

## Contribution

The Asclepius tube is introduced as a low-cost, practical solution to optimize saline-immersion endoscopic submucosal dissection.

## Key findings

- The Asclepius tube successfully maintained fluid balance during a 170-minute ESD procedure.
- The procedure achieved an en bloc resection with an R0 histopathological result.
- The device enhances patient comfort and allows use of conscious sedation without affecting scope maneuverability.

## Abstract

Endoscopic submucosal dissection (ESD) is recognized as the reference standard for en bloc resection of large colorectal and gastric lesions, but conventional carbon dioxide–insufflation ESD presents challenges. The saline-immersion/irrigation technique (SITE) offers multiple advantages, especially when combined with a drainage tube. The video showcases the set-up and practical use of the “Asclepius tube” to optimize SITE-ESD, maintaining its advantages, allowing for a more efficient dissection, keeping an adequate balance of fluid and improving patient comfort.

A 72-year-old man with a 60-mm sessile lesion (Paris 0-Is) at the rectosigmoid junction was referred for ESD. SITE-ESD was performed using the pocket-creation method with the patient under conscious sedation. The Asclepius tube was wrapped around the scope and connected to continuous low-flow suction (<20 kPa) to drain redundant saline and gas.

The lesion was successfully removed en bloc in 170 minutes (dissection speed of 20.1 mm2/min, by 2 fellows training in ESD), without significant intra/postprocedural adverse events. Histopathology confirmed R0 resection of a low-grade dysplastic tubulevillous adenoma.

The Asclepius tube is low cost and easy to set up; it helps maintain optimal fluid balance during SITE-ESD, thus enhancing patient comfort and enabling procedures to be performed with the patient under conscious sedation and without compromising scope maneuverability. Further prospective comparative studies are warranted to validate our findings.