ESD (IIa+IIc 18 mm) in sigmoid colon (F.J. Gallego)
T13-Polipectomía EMR y ESD / julio 20, 2018

An ESD of a lesion with IIa + IIb morphology in the sigmoid colon is exposed. This is our DSE number 11 in the hospital in Poniente. A 1.5 mm BT flush-knife and coagrasper for hemostasis has been used as a hydrodissector. Demirex has been used as a submucosa injection solution (excellent master formula of our friend J. Antonio Morales Molina from the Pharmacy service of the Poniente Hospital). Many thanks to Dr. Katsumi Yamamoto (my dear Japanese friend and ESD world expert) for his good advice in this difficult learning curve of the ESD as well as my good friends, Dr. Rosón (an Andalusian and Spanish expert of the ESD), Dr. Guilarte (friend for 24 years and excellent endoscopist) and of course the group of the «DSE polygonera» (a large endoscopic family).  

Cecal ESD (Is morphology 6 cm). Dr. Gallego and Dr. Rosón
T13-Polipectomía EMR y ESD / julio 20, 2018

A big cecal lesion (6 x 4 cm) is resected by ESD. The case has been difficult due to poor maneuverability and bleeding during the procedure. At the end of the dissection, it was necessary to change the colonoscope and cap. A standard colonoscope with a distal diameter of 12 mm and a working channel of 3.7 mm has been used. We also had to change to a straight hood to improve visibility. Thanks to Dr. Rosón to help me in this case.

ESD IIa + IIc sigmoid colon (F.J. Gallego)
T13-Polipectomía EMR y ESD / junio 9, 2018

ESD of a lesion with morphology IIa + IIc (12 mm) in sigmoid colon. It has been used ST-Hood, flushknife BT 1.5 mm, coagrasper and Resolution clip 360º. These lesions, although small, due to their central depression and greater risk of malignancy, must be extruded by submucosal endoscopic dissection.

ESD of a recurrent adenoma after rectal PEMR (Dr. Julio Guilarte. Hospital de Baza)

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.  

Rectal ESD. First case in Baza Hospital (Dr. Julio Guilarte. Hospital de Baza)

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.

LESION LST-G / IIa + IIc (18 mm) IN ASCENDING COLON. HYBRID RESECTION (F. J. Gallego)

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.

Non-homogenous LST-G postanal (9 cm). DSE using the tunnel technique (Pedro J. Rosón)
T13-Polipectomía EMR y ESD / abril 23, 2018

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.

TRANSLATE