A 67 years old male. Rectal PEMR two years ago. Post-polypectomy colonoscopy surveillance: LST-G 20 mm recurrence lesion in the rectal posterior wall, 20 mm from dentate line. This was the second case performed in Baza Hospital by Dr. Julio Guilarte, supervised by Dr. Katsumi Yamamoto (JCHO Hospital, Osaka) and suported by Dr. F. Gallego, Dr. PJ. Rosón and Dr. FM. Fernández Cano. Thanks to my friends and colleagues.
A 70 years old male with previous rectal cancer and anastomosis T-T 9 cm from dentate line. A LST-NG lesion 20 mm size, situated in the posterior rectal wall, close to dentate line, was found. This was the first case performed in Baza Hospital by Dr. Julio Guilarte, supervised by Dr. Katsumi Yamamoto (JCHO Hospital, Osaka) and suported by Dr. F. Gallego, Dr. PJ. Rosón and Dr. FM. Fernández Cano. Thanks to my friends and colleagues.
A 45-year-old patient with a family history of CRC (father diagnosed with ascending colon cancer at 64 years of age, dying at 68 years of age). It was found in a family screening colonoscopy of an ascending colon lesion of 18 mm with morphology LST-G / IIa + IIc. The lesion was resected with a hybrid technique due to the poor maneuverability of the colonoscope and severe submucosal fibrosis.
Impressive case where a DSE of a large lesion of postanal localization with non-homogenous LST-G morphology performed by Dr. Rosón. The technique used has been tunneling, where initially an incision is created in the anal margin of the lesion somewhat larger than 1 cm that allows access to the submucosal plane. Once the tunnel is made, an incision of similar size is made on the oral side of the lesion. Throughout this phase an endoknive Flushknife BT 1.5 mm has been used. The next phase is the lateral extension of the dissection where an IT-Nano was used. Finally, the lateral incisions were excised to resect all the lesion. In this area the vessels are redundant and thermocoagulated with coagrasper. As an injection solution as well as that used for the Flushknife it was a mixture of Voluven + indigo carmine + adrenaline.
Very interesting technique of hybrid ESD carried out with a single instrument (handle of Poilpectomy Snare Inflator of Medwork) by Dr. Rosón (Hospital Quirón, Málaga). This technique is very useful for flat lesions (like this 22 mm with LST-G morphology) located in areas of the colon with poor maneuverability such as the hepatic flexure.
At the beginning of the DSE technique, it is important to perform in small lesions and in locations where endoscopic maneuverability is very good. In this case a flushknife 1.5 mm BT has been used and the scar closed with hemoclips
En el aprendizaje de la DSE de colon es recomendable empezar por lesiones rectales < 2 cm para poder familiarizarse con los movimientos del endoscopio, el material, las posibles complicaciones y su manejo, etc. En esa fase me encuentro yo ahora mismo. En la curva de aprendizaje es muy importante el entrenamiento previo en modelo animal ex-vivo (> 50 casos), modelo animal vivo (> 30 casos) para finalmente empezar en humanos. Se ha utilizado un colonoscopio corto (1330 mm) Fujifilm EC-580RD-M, con un canal de 3.2 mm con excelente maniobrabilidad y muy buena visión. Por supuesto la técnica se ha hecho con CO2, usando como bisturí un flushknife BT de 1.5 mm. Es de gran ayuda el uso de capuchones ST-Hood de la casa Fujifilm. Pongo este enlace del canal “California Interventional Endoscopy” dada la gran utilidad que puede tener al inicio del aprendizaje de la técnica, el uso del SB-Junior.
Se expone el caso de una lesión de 3 cm situada en colon ascendente, frente a la válvula ileocecal, con morfología granular homogénea (LST-G) resecada con técnica de mucosectomía piecemeal en 3 fragmentos (PEMR). La escara se cierra con 4 hemoclips. Este tipo de lesiones es muy buena indicación para mucosectomía en bloque o en fragmentos (EPMR) dado que la tasa de invasión submucosa es < 20 %.
We present the case of a 56yo man with previous resection of adenomatous 0-Is 15 mm pop in rectum. 6 months after resection, a new colonoscopy is performed with the presence of a small 0-Is polyp over the scar with non-lifting sign. The patient was evaluates to perform FTRD. A Video showing the set up of the FTRD Endoscopic Full Thickness Resection Device from OVESCO (Owned by SynMed UK):
An ESD assay is presented in live animal model (pig stomach) using the new Finemedix knives models (especially ClearCut knife O-type 4 mm). Many thanks to the company ST-Endoscopies for all the facilities provided. Promocional video of Finemedix: