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When EMR Won’t Do: Hybrid ESD for a Large Ascending Colon Polyp

Jennifer Hrabe, MD, Ipek Sapci, MD, Cigdem Benlice, MD, Emre Gorgun, MD. Cleveland Clinic Foundation

Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) are advanced techniques that can be used for large polyps on difficult locations. ESD provides a specimen involving the submucosa and allows pathological evaluation for submucosa invasion.

A 79 year old female who had regular screenings with colonoscopy without any reported lesions was found to have a 5 cm sessile colonic lesion located opposite wall of ileocecal valve. She was referred for advanced endoscopic resection. After initial colonoscopy and locating the lesion, ESD solution was injected under the lesion and following this circumferential incision was completed. Submucosal dissection was carried and the lesion was removed with snare in a “hybrid” fashion.  A small defect was observed and an over the scope clip was used to close it. Patient was discharged home on postoperative day one. A hybrid approach of ESD with EMR for large lesions can be safely performed in experienced hands. 


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

Abstract ID: 86434

Program Number: V206

Presentation Session: Wednesday Video Loop (Non CME)

Presentation Type: VideoLoop

505

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