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Underwater endoscopic resection: an alternative for difficult colorectal polyps
VIDEO CASE SERIES
Underwater endoscopic resection: an alternative for difficult colorectal polyps Dalton Marques Chaves, PhD,1,2 Hélcio Pedrosa Brito, MD,1 Lumi Tomishige Chaves,3 Adriana Vaz Safatle-Ribeiro, PhD,2 Gilberto Fava, PhD,4 Eduardo Guimarães Hourneaux de Moura, PhD,2 Beatriz Mônica Sugai, PhD1 São Paulo, Barretos, Brazil
Background and Aims: Underwater endoscopic resection can be an alternative to standard resection techniques to remove difficult colorectal polyps. This video shows 4 cases of underwater resection of large colorectal polyps. Methods: Underwater resection consists of complete filling of the lumen through the accessory channel, using an infusion pump followed by snare resection of the polyp. We present 4 cases: a 3-cm pseudodepressed laterally spreading tumor (LST) in the sigmoid colon, a 6-cm pedunculated polyp with a thick stalk in the sigmoid, a 7-cm sessile lesion in the midrectum, and a 4-cm LST in the distal rectum close to the dentate line, resected with a monofilament snare or a multifilament snare. Results: All tumors were successfully resected without any adverse events or residual lesions during follow-up. Conclusions: The underwater technique is a good alternative to standard resection techniques to remove difficult colorectal lesions. (Gastrointest Endosc 2016;1:82-4.)
Underwater endoscopic resection is an alternative technique to standard polypectomy in the management of difficult polyps. This video (Video 1, available online at www. VideoGIE.org) shows 4 cases of underwater resection of large colorectal polyps: a 3-cm pseudodepressed laterally spreading tumor (LST) in the sigmoid colon that could not be resected with standard mucosectomy (Fig. 1A); a 6-cm pedunculated polyp with a thick stalk in the sigmoid colon (Fig. 2A), in which the loop application was possible only under water; a 7-cm sessile lesion in the midrectum (Fig. 3A); and a 4-cm LST in the distal rectum, close to the dentate line (Fig. 4A). One endoscopist performed all procedures while the patients were under conscious
sedation. The technique consisted of infusion of water through the accessory channel, using an infusion pump until complete filling of the lumen was achieved, followed by snare resection without prior submucosal injection.1 A monofilament snare was used to resect the LST lesions in the sigmoid colon and rectum, and a multifilament snare was used for the other 2 lesions. The Erbe (Erbe Elektromedizin GmbH, Tuebingen, Germany) electrosurgical setting was endocut mode effect 2, cut interval 6, and cut duration 1 for all lesions. All lesions would have been difficult to resect by conventional mucosectomy or polypectomy, and in 2 of them previous attempted resections had failed. There were no adverse events, and no
Abbreviation: LST, laterally spreading tumor.
Received August 25, 2016. Accepted November 11, 2016.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Current affiliations: Fleury Medicine and Health (1), Clinics Hospital of São Paulo University (2), Medical School of the Federal University of São Paulo (3), São Paulo, Brazil, Cancer Hospital of Barretos, Barretos, Brazil (4).
Copyright ª 2016 The Authors. Published by Elsevier, Inc. on behalf of the American Society for Gastrointestinal Endoscopy. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
Reprint requests: Dalton Marques Chaves, PhD, Fleury Medicine and Health, Clinics Hospital of São Paulo University, Rua Montezuma, 183, São Paulo, Brazil 05436-080.
http://dx.doi.org/10.1016/j.vgie.2016.11.001 Written transcript of the video audio is available online at www.VideoGIE.org.
82 VIDEOGIE Volume 1, No. 4 : 2016
www.VideoGIE.org
Chaves et al
Video Case Series
Figure 1. A, Pseudodepressed laterally spreading tumor in the sigmoid colon. B, After resection.
Figure 2. A, Giant pedunculated polyp in the sigmoid colon. B, After resection.
Figure 3. A, Giant sessile lesion in the midrectum. B, After resection.
www.VideoGIE.org
Volume 1, No. 4 : 2016 VIDEOGIE 83
Video Case Series
Chaves et al
Figure 4. A, Laterally spreading tumor in the distal rectum. B, After resection.
residual lesions were seen at follow-up colonoscopy. The underwater technique is a good alternative to standard techniques to resect difficult colorectal lesions, including those in which conventional resection techniques have failed.
84 VIDEOGIE Volume 1, No. 4 : 2016
REFERENCE 1. Binmoeller KF, Weilert F, Shah J, et al. “Underwater” EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc 2012;75:1086-91.
www.VideoGIE.org
Underwater endoscopic resection: an alternative for difficult colorectal polyps Dalton Marques Chaves, PhD,1,2 Hélcio Pedrosa Brito, MD,1 Lumi Tomishige Chaves,3 Adriana Vaz Safatle-Ribeiro, PhD,2 Gilberto Fava, PhD,4 Eduardo Guimarães Hourneaux de Moura, PhD,2 Beatriz Mônica Sugai, PhD1 São Paulo, Barretos, Brazil
Background and Aims: Underwater endoscopic resection can be an alternative to standard resection techniques to remove difficult colorectal polyps. This video shows 4 cases of underwater resection of large colorectal polyps. Methods: Underwater resection consists of complete filling of the lumen through the accessory channel, using an infusion pump followed by snare resection of the polyp. We present 4 cases: a 3-cm pseudodepressed laterally spreading tumor (LST) in the sigmoid colon, a 6-cm pedunculated polyp with a thick stalk in the sigmoid, a 7-cm sessile lesion in the midrectum, and a 4-cm LST in the distal rectum close to the dentate line, resected with a monofilament snare or a multifilament snare. Results: All tumors were successfully resected without any adverse events or residual lesions during follow-up. Conclusions: The underwater technique is a good alternative to standard resection techniques to remove difficult colorectal lesions. (Gastrointest Endosc 2016;1:82-4.)
Underwater endoscopic resection is an alternative technique to standard polypectomy in the management of difficult polyps. This video (Video 1, available online at www. VideoGIE.org) shows 4 cases of underwater resection of large colorectal polyps: a 3-cm pseudodepressed laterally spreading tumor (LST) in the sigmoid colon that could not be resected with standard mucosectomy (Fig. 1A); a 6-cm pedunculated polyp with a thick stalk in the sigmoid colon (Fig. 2A), in which the loop application was possible only under water; a 7-cm sessile lesion in the midrectum (Fig. 3A); and a 4-cm LST in the distal rectum, close to the dentate line (Fig. 4A). One endoscopist performed all procedures while the patients were under conscious
sedation. The technique consisted of infusion of water through the accessory channel, using an infusion pump until complete filling of the lumen was achieved, followed by snare resection without prior submucosal injection.1 A monofilament snare was used to resect the LST lesions in the sigmoid colon and rectum, and a multifilament snare was used for the other 2 lesions. The Erbe (Erbe Elektromedizin GmbH, Tuebingen, Germany) electrosurgical setting was endocut mode effect 2, cut interval 6, and cut duration 1 for all lesions. All lesions would have been difficult to resect by conventional mucosectomy or polypectomy, and in 2 of them previous attempted resections had failed. There were no adverse events, and no
Abbreviation: LST, laterally spreading tumor.
Received August 25, 2016. Accepted November 11, 2016.
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
Current affiliations: Fleury Medicine and Health (1), Clinics Hospital of São Paulo University (2), Medical School of the Federal University of São Paulo (3), São Paulo, Brazil, Cancer Hospital of Barretos, Barretos, Brazil (4).
Copyright ª 2016 The Authors. Published by Elsevier, Inc. on behalf of the American Society for Gastrointestinal Endoscopy. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
Reprint requests: Dalton Marques Chaves, PhD, Fleury Medicine and Health, Clinics Hospital of São Paulo University, Rua Montezuma, 183, São Paulo, Brazil 05436-080.
http://dx.doi.org/10.1016/j.vgie.2016.11.001 Written transcript of the video audio is available online at www.VideoGIE.org.
82 VIDEOGIE Volume 1, No. 4 : 2016
www.VideoGIE.org
Chaves et al
Video Case Series
Figure 1. A, Pseudodepressed laterally spreading tumor in the sigmoid colon. B, After resection.
Figure 2. A, Giant pedunculated polyp in the sigmoid colon. B, After resection.
Figure 3. A, Giant sessile lesion in the midrectum. B, After resection.
www.VideoGIE.org
Volume 1, No. 4 : 2016 VIDEOGIE 83
Video Case Series
Chaves et al
Figure 4. A, Laterally spreading tumor in the distal rectum. B, After resection.
residual lesions were seen at follow-up colonoscopy. The underwater technique is a good alternative to standard techniques to resect difficult colorectal lesions, including those in which conventional resection techniques have failed.
84 VIDEOGIE Volume 1, No. 4 : 2016
REFERENCE 1. Binmoeller KF, Weilert F, Shah J, et al. “Underwater” EMR without submucosal injection for large sessile colorectal polyps (with video). Gastrointest Endosc 2012;75:1086-91.
www.VideoGIE.org