Recurrent sessile serrated adenoma invading the site of previous appendectomy effectively resected by endoscopic submucosal dissection with double-clip and rubber band traction
Year: 2020
Type: article
Study design: Case Report
Abstract: Endoscopic submucosal dissection (ESD) became the treatment of choice for colorectal superficial neoplastic lesions larger than 25 mm to achieve complete and curative resection, avoiding unnecessary surgery [ 1 ]. Double-clip and rubber band traction (DCT-ESD) was demonstrated to be a useful tool for Western endoscopists, allowing a better, faster, and safer procedure [ 2 ]. Moreover, for challenging lesions such as those on the site of previous appendectomy, or recurrent lesions, DCT-ESD allowed a promising outcome as well [ 3 ] [ 4 ]. We report the case of a 67-year-old man who underwent endoscopic mucosal resection of a 13-mm sessile serrated adenoma on the site of previous appendectomy in 2014. In 2019, a recurrent lesion was found, which had been incompletely resected by EMR. The patient was then referred to our center. During the procedure, we identified a hemoclip placed within the lesion. We decided to perform DCT-ESD to achieve en bloc resection without removing the clip, to avoid any defect on the lesion ([ Video 1 ]). After submucosal injection, there was a poor lifting sign, which indicated severe fibrosis beneath the lesion ([ Fig. 1 ]). Good traction was achieved after the placement of our traction system. Submucosal dissection was then performed very carefully and slowly. Despite the two holes on the cut specimen, we could successfully finish the resection, with a 25 × 30 mm en bloc specimen in 30 minutes, without any adverse events. Six clips (two during submucosal dissection and four at the end of the procedure) were used to prevent any delayed perforation or bleeding ([ Fig. 2 ], [ Fig. 3 ]). Pathological examination revealed complete R0 resection of a sessile serrated adenoma without any dysplasia. Video 1 Recurrent sessile serrated adenoma invading the site of previous appendectomy effectively resected by endoscopic submucosal dissection with double-clip and rubber band traction. Quality: mobile 360 480 720 Download Fig. 1 Recurrent sessile serrated adenoma (SSA) on the site of previous appendectomy. a A hemoclip was seen within the resection site. b SSA under narrow-band imaging (NBI) examination; c SSA underwater and NBI examination. d Poor lifting sign after submucosal injection. Fig. 2 Endoscopic submucosal dissection with double-clip and rubber band traction. a Circumferential incision. b Good traction achieved after placement of the traction system. c Two holes on the cut specimen. d Six clips placed on the resection site. Fig. 3 The 25 × 30 mm resected specimen stretched onto a cork board. Thanks to our traction system, this doubly difficult lesion (appendiceal and recurrent lesion) could be effectively resected endoscopically. Clip placement during dissection was particularly facilitated by our traction system by creating a better plane for clip positioning. Thus, this strategy remains promising in our center and potentially for other types of challenging lesions. Endoscopy_UCTN_Code_TTT_1AQ_2AD Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos Publication History Publication Date: 27 March 2020 (online) © Georg Thieme Verlag KG Stuttgart · New York
Source: Endoscopy
DOI: 10.1055/a-1133-4260
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3013396237