Endoscopy 2022; 54(01): E34-E35
DOI: 10.1055/a-1362-9196
E-Videos

Endoscopic submucosal dissection of a laterally spreading tumor involving a colonic diverticulum using the counter-traction technique

Thomas Lambin
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
2   Inserm U1032, Labtau, Lyon, France
,
Jérémie Jacques
3   Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
Jérôme Rivory
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Florian Rostain
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Timothée Wallenhorst
4   Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
,
Mathieu Pioche
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
2   Inserm U1032, Labtau, Lyon, France
› Author Affiliations

Endoscopic submucosal dissection (ESD) is the technique of choice for the resection of superficial colorectal lesions larger than 20 mm [1], but the procedure can be technically challenging in some situations. If a lesion involves a diverticulum, there is fear of a higher risk of perforation due to the lack of muscle layer. However, ESD has recently been described as safe and effective in this particular case [2]. Use of a clip and rubber band (counter-traction technique [3]) can help to achieve a satisfying resection with higher technical comfort. This technique has been proved to be effective and safe for resection of neoplastic lesions involving the appendiceal orifice [4]. However, few data are available for lesions involving a diverticulum [5].

We report the case of a 40 × 30 mm nongranular laterally spreading tumor (NG-LST) deeply invading a colonic diverticulum (Type 3 LST) ([Fig. 1]), which was resected with ESD using the counter-traction technique ([Video 1]).

Zoom Image
Fig. 1 Nongranular laterally spreading tumor deeply invading a colonic diverticulum.

Video 1 Endoscopic submucosal dissection of a laterally spreading tumor involving a colonic diverticulum using the counter-traction technique.


Quality:

After submucosal injection around the diverticulum, complete circumferential incision and deep trimming were performed. The first clip grasping a rubber band was fixed at one side of the lesion and a second clip grasping the same rubber band was fixed at the opposite colonic wall ([Fig. 2]). This counter-traction technique allowed better exposition of the submucosae area under the diverticulum, thus strongly facilitating an en bloc resection ([Fig. 3]). The ulcer floor of the diverticulum was closed by two clips at the end of the procedure to prevent delayed perforation [2]. The patient was discharged the following day without any adverse events. The histopathology report showed an adenoma with high grade dysplasia and a complete en bloc resection (R0).

Zoom Image
Fig. 2 Counter-traction of the lesion with clips and rubber band.
Zoom Image
Fig. 3 The resected piece.

This case report, along with others [5], describes the feasibility of ESD with counter-traction method for resection of LSTs deeply invading a diverticulum.

Endoscopy_UCTN_Code_TTT_1AQ_2AJ

Endoscopy 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



Publication History

Article published online:
23 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
  • 2 Muramoto T, Ohata K, Sakai E. et al. Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum. Surg Endosc 2020; DOI: 10.1007/s00464-020-07795-y.
  • 3 Jacques J, Charissoux A, Bordillon P. et al. High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band. Endosc Int Open 2019; 07: E1166-E1174
  • 4 Oung B, Rivory J, Chabrun E. et al. ESD with double clips and rubber band traction of neoplastic lesions developed in the appendiceal orifice is effective and safe. Endosc Int Open 2020; 08: E388-E395
  • 5 Albouys J, Geyl S, Charissoux A. et al. Counter-traction using clips and rubber banding for endoscopic submucosal dissection of a laterally spreading tumor involving a diverticulum in the colon. Endoscopy 2019; 51: E295-E296