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Giant Rectal ESD With Tissue Retraction: A Unique Approach

Sam K Sharma, James E East, Adam A Bailey. Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, U.K.

INTRODUCTION: Hypothesis: The use of a novel endoscopic tissue retraction device was 1) feasible and 2) facilitated effective and efficient dissection of giant colonic polyps.

Giant colonic polyps (>4cm diameter) are often treated by surgical resection. 

Endoscopic treatment options include piecemeal EMR or ESD but resection of large polyps, is more time-consuming and requires more resources compared with polypectomy of smaller lesions.

To overcome these challenges we have previously described a tissue retraction method to improve visualisation and increase dissection efficiency and effectiveness.

Here we report the first case series of 3 patients giant polyps removed via ESD using this technique.

METHODS AND PROCEDURES:

  • 3 patients – (2 female and 1 male)
  • Average age – 59.3 years
  • Procedure:
  • Patient was prepared and given conscious sedation according to trust guidelines.
  • We began in left lateral position and moved as needed
  • ESD with retraction procedure:
  • Circumferential incision using ESD knife
  • Mucosal edge clipped to foreballoon
  • Retraction varied according to dissection
  • Specimen captured in roth net and removed from patient
  • Mucosal defect inspected and clips applied as necessary
  • Equipment:
  • Olympus gastroscope (GIF) or colonscope (PCF)
  • ESD cap
  • Fuji flushknife
  • Lumendi Dilumen
  • Haemostatic clips
  • Saline or sigmavisc submucosal injection
  • Olympus needle injector
  • ERBE electrosurgical generator

RESULTS:

  • En-bloc resection completed in all cases.
  • Average Procedure Time (minutes) = 127.4
  • Average Specimen diameter size (cm) = 6.8
  • Average Rate of dissection (cm2/h) = 17.2
  • No complications
  • Histology was not available at the time of abstract submission.

CONCLUSION: The use of a novel endoscopic tissue retraction device was feasible and effective in the dissection of giant colonic polyps.

This was mediated via 1) improved tissue tension and 2) perforating blood vessel visibility facilitating efficient dissection and appropriate coagulation mediated therapy respectively.

Further expansion to this case series is on-going.

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94930

Program Number: V151

Presentation Session: Video Loop Day 1

Presentation Type: VideoLoop

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