Talal Alzghari, MD, Kota Momose, MD, PhD, Yohei Kono, MD, PhD, Parul Shukla, MD, Kelly Garrett, MD, FACS. Weill Cornell Medicine/NewYork Presbyterian Hospital
INTRODUCTION: Challenging endoluminal large bowel therapies may be due to intrinsic lesion factors such as size, anatomical location or whether on a fold or around a bend. Regarding sigmoid colon lesions, these may be challenging to treat owing to the untethered nature and relative redundancy of the sigmoid. For such cases, surgical resection could become an option, but most patients and doctors wish to avoid this option especially in benign disease. Here we demonstrate two cases of successful endoscopic polyp removal of large lesions in the sigmoid colon that were very difficult to visualize during routine colonoscopy, but were easily and safely removed using a novel double balloon overtube device (DiLumen, Lumendi Ltd., Westport CT) with the colonoscope.
METHODS AND PROCEDURES: Two patients, a 41-year-old male and a 61-year-old female, with bleeding submucosal tumors at sigmoid colon (> 3cm diameter) were initially referred for colectomy. The tumors occupied at least half of the intestinal lumen and the stalk was located around a bend of the sigmoid colon. Therapeutic colonoscopy was planned with a double balloon device (DiLumen). One of the two balloons, placed on the tip of the sheath, is designed to be extendable about 15cm beyond the endoscope tip. This mechanism helps to straighten and stabilize the colon, and creates a “Therapeutic Zone”.
RESULTS: By extending the fore-balloon and pulling the whole system with both balloon inflated, sigmoid colon was straightened, with improved visualization of the lesions. This allowed us to remove the polyps easily using routine polypectomy snares in less than 20 minutes in each case. No perforations occurred, and the two patients were discharged within 24 hours after the procedure with no significant complications. There were also no late phase complications at one month later. The pathological diagnosis was submucosal lipoma in both cases.
CONCLUSION: Colonoscopy using a novel double balloon overtube device helped improve visualization in the sigmoid colon by straightening the colon and creating a very stable “Therapeutic Zone”. This technique appears promising and may expand indications and safety of endoluminal therapies in the near future.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95395
Program Number: V113
Presentation Session: Colorectal Videos II
Presentation Type: Video
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