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Precutting EMR for cecal tumors extending to the appendiceal orifice
VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Precutting EMR for cecal tumors extending to the appendiceal orifice
Figure 1. Chromoendoscopic view of sessile, 20-mm cecal polyp extending to the appendiceal orifice.
Endoscopic resection for cecal tumors extending to the appendiceal orifice is considered difficult because the narrow lumen hampers clear observation of the tumor margin. Residual adenoma at the orifice may be more difficult to remove endoscopically because of increased narrowing of the lumen by scarring after initial resection. Therefore, R0 resection is desirable at an initial treatment for such lesions. This case illustrates precutting EMR for R0 resection of a cecal tumor involving the appendiceal orifice. A 65-year-old-man was referred to our hospital for the treatment of a cecal polyp. Colonoscopy showed a sessile 20-mm polyp extending to the appendiceal orifice (Fig. 1). Chromoendoscopy with indigo carmine spraying demonstrated a type IV pit pattern by Kudo’s classification. Thus, the polyp was diagnosed as an adenoma, and we decided to perform EMR. A successful injection shifted the lesion away from the appendiceal orifice, exposing the tumor margin. Subsequently, a onethird circumferential mucosal incision was done by use of a snare tip (Video 1, available online at www.giejournal.org).
www.giejournal.org
After the snare was positioned into the mucosal incision, the lesion was successfully captured. Complete en bloc resection was achieved with no adverse event. Pathologic examination showed a high-grade adenoma with tumor-free margins.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Kenichiro Imai, MD, Kinichi Hotta, MD, Naomi Kakushima, MD, PhD, Hiroyuki Ono, MD, PhD, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan http://dx.doi.org/10.1016/j.gie.2015.05.007
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
Precutting EMR for cecal tumors extending to the appendiceal orifice
Figure 1. Chromoendoscopic view of sessile, 20-mm cecal polyp extending to the appendiceal orifice.
Endoscopic resection for cecal tumors extending to the appendiceal orifice is considered difficult because the narrow lumen hampers clear observation of the tumor margin. Residual adenoma at the orifice may be more difficult to remove endoscopically because of increased narrowing of the lumen by scarring after initial resection. Therefore, R0 resection is desirable at an initial treatment for such lesions. This case illustrates precutting EMR for R0 resection of a cecal tumor involving the appendiceal orifice. A 65-year-old-man was referred to our hospital for the treatment of a cecal polyp. Colonoscopy showed a sessile 20-mm polyp extending to the appendiceal orifice (Fig. 1). Chromoendoscopy with indigo carmine spraying demonstrated a type IV pit pattern by Kudo’s classification. Thus, the polyp was diagnosed as an adenoma, and we decided to perform EMR. A successful injection shifted the lesion away from the appendiceal orifice, exposing the tumor margin. Subsequently, a onethird circumferential mucosal incision was done by use of a snare tip (Video 1, available online at www.giejournal.org).
www.giejournal.org
After the snare was positioned into the mucosal incision, the lesion was successfully captured. Complete en bloc resection was achieved with no adverse event. Pathologic examination showed a high-grade adenoma with tumor-free margins.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Kenichiro Imai, MD, Kinichi Hotta, MD, Naomi Kakushima, MD, PhD, Hiroyuki Ono, MD, PhD, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan http://dx.doi.org/10.1016/j.gie.2015.05.007
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1