Strategies to successfully complete complex ESD in the colon

Introduction

Endoscopic submucosal dissection (ESD) is challenging in the colon. Lesions with fibrosis and located in diverticular areas add extra technical difficulty [1] [2] [3].

We describe the case of a 71-year-old woman with a sigma 20-mm nongranular, laterally spreading tumor (LST NG) with a type Vi pit pattern and NICE 2, surrounded by diverticula and in contact with a tattoo ([Fig. 1] and [Fig. 2]). A tattoo close to a lesion can make its resection even harder [4].

Fig. 1 Lesion.

Fig. 2 Lesion i-Scan.

Publikationsverlauf

Eingereicht: 06. Januar 2024

Angenommen nach Revision: 14. März 2024

Artikel online veröffentlicht:
25. Juli 2024

• References

• 1 Ikezawa N, Toyonaga T, Tanaka S. et al. Feasibility and safety of endoscopic submucosa dissection for lesions in proximity to a colonic diverticulum. Clinc Endosc 2022; 55: 417-425
• 2 Muramoto T, Ohata K, Sakai E. et al. Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum. Surg Endosc 2021; 35: 3479-3487
• 3 Jimenez-García VA, Yamada M, Ikematsu H. et al. Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series. Endosc Int Open 2019; 7: E664-E671
• 4 Barquero D, González V, García O. et al. Ways to perform an endoscopic tattoo. Prospective and randomized study in patients with colorectal neoplasm. Rev Esp Enferm Dig 2021; 113: 519-523
• 5 Ramos Zabala F, García M, Domínguez A. et al. Combination of immersion in saline solution, pocket-creation method, water-jet hydrodissection, and hybrid knife “probe mode” simplifies endoscopic submucosa dissection in giant rectal polyp. VideoGIE 2019; 4: 478-480