World Congress at ACG2017
Symposium 2D: Live From Orlando! The 5th Annual Endoscopy Video Forum
V2 - Underwater Complex Colonic ESD With Retraction and Specimen Retrieval: First Human Experience Using a Double Balloon Device
Monday, October 16
5:14 PM - 5:21 PM
Location: W414 (Level 4)
Sam Sharma, MD
New York-Presbyterian/Weill Cornell Medical Center
New York, New York
Category: Endoscopy Video Forum Sub-Category: Winthrop abstract.mp4
Sam Sharma, MD1, Kota Momose, MD1, Krishna Gurram, MD2, Stavros Stavropoulos, MD2
1New York-Presbyterian/Weill Cornell Medical Center, New York, NY; 2Winthrop University Hospital, New York, NY
Complex colorectal polyps (defined as >2cm) or those positioned in difficult anatomic locations may be major endoscopic challenges. Underwater ESD (UESD) has recently emerged as a potential technical solution to facilitate removal of complex polyps. The major benefits of UESD are: gravity-assistance independence, magnification, hydro-dissection, reduced tissue burn artifact and electrosurgical smoke reduction. In addition, endolumenal tissue traction and counter-traction, cornerstone principles of effective dissection, have been confined to limited methods ranging from clipping/retraction to using two scopes. Despite clear benefits of ESD (R0 resection and low recurrence rate), it remains a technically challenging procedure with higher perforation rates compared to EMR. In this case, we employed a hybrid approach using UESD facilitated by a novel endoscopic double balloon system which permitted polyp tissue retraction, to decrease technical difficulty and increase safety.
Case Description: 68 year old male, large complex polyp located in the ascending colon.
PMH: OSA, PVC, HLD, HTN
UESD-R technique (briefly): The balloons were deployed behind and in front of the lesion. After the balloons were inflated, a sealed ‘therapeutic zone’ was created. Water aggregation was due to patient and polyp position (6 o’clock). A mucosal incision was made at the proximal lesion margin and developed. The incision leading edge was developed further using underwater dissection. At the appropriate point the mucosal edge was clipped to the base of the fore balloon. Using variable tension on the fore balloon, tissue dissection continued until resection. After the procedure, the specimen was removed using the fore-balloon as a specimen retrieval bag.
UESD-R total procedural time was 120 minutes. No perforations were observed.
Paris classification was IIa
Final histology: Tubulovillous adenoma
The double balloon system enabled UESD-R. This led to an enhanced sense of stability of the scope in a difficult situation. The combined benefits of UESD and retraction appeared to be additive when tackling complex polyps unamenable to gravity assistance and should be studied further.
Supported by Industry Grant: No
Disclosures: Does Disclose
Sam Sharma: Lumendi - Patent Holder.
All other authors have indicated no relevant financial relationships.
The patient's EKG on arrival demonstrating several areas of ST change, especially pronounced in V2 and V3
Cardiac MR demonstrating enhancement of the pericardium, most prominent in the right ventricle
Citation: . UNDERWATER COMPLEX COLONIC ESD WITH RETRACTION AND SPECIMEN RETRIEVAL: FIRST HUMAN EXPERIENCE USING A DOUBLE BALLOON DEVICE. Program No. V2. World Congress of Gastroenterology at ACG2017 Meeting Abstracts. Orlando, FL: American College of Gastroenterology.