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

Background and Aims: 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. Methods: 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. Results: The lesion was successfully removed en bloc in 170 minutes (dissection speed of 20.1 mm Conclusions: 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.