Hybrid endoscopic submucosal dissection using a full-thickness resection device allows en bloc resection of a large adenoma deeply invading the appendix

摘要

Video 1 A hybrid full-thickness resection is performed on a large laterally spreading tumor invading the appendectomy site. The lesion is first incised circumferentially then endoscopic submucosal dissection is performed using the clip and rubber-band traction method, which is followed by resection using the full-thickness resection device and a polypectomy snare. Georg Thieme Verlag. Please enable Java Script to watch the video.Download Fig. 2 Schematic of the first stage of the procedure, showing: a circumferential incision; b endoscopic submucosal dissection using clip traction. Fig. 3 Schematic of the second stage of the procedure, illustrating: a, b resection using the full-thickness resection device; c the mucosal view after full-thickness resection with the clip in place. The resected specimen ([Fig. 4]) was examined histopathologically and showed an R0 full-thickness resection of a low grade dysplastic adenomatous lesion. The patient was discharged 24 hours later and no complications occurred during 3 months of follow-up. Fig. 4 Photographs of: a the specimen removed by the full-thickness resection device; b the specimen after placement on a cork board. To our knowledge, this is the first case of resection using hybrid dissection and an FTRD. This new strategy may allow resection of large fibrous superficial lesions that are not accessible to standard endoscopic resection techniques. Our case is particularly interesting as we removed a lesion invading the appendectomy site en bloc with free margins. Future studies are required to validate this new hybrid resection technique.Endoscopy_UCTN_Code_TTT_1AQ_2ADEndoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.