Endoscopy 2013; 45(S 02): E239-E240
DOI: 10.1055/s-0032-1309711
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Traction device to remove an adenoma in the appendiceal orifice by endoscopic submucosal dissection

T. Takeda
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
T. Murakami
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
N. Sakamoto
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
S. P. Goto
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
H. Ritsuno
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
H. Ueyama
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
H. Mori
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
K. Matsumoto
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
T. Shibuya
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
T. Osada
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
A. Nagahara
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
T. Ogihara
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
,
S. Watanabe
Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
05 September 2013 (online)

Adenomatous polyps of the appendix are rare [1] [2]; in some cases polypectomy is unsuccessful and surgical treatment is required [3]. Appendiceal polypectomy at colonoscopy is carried out extremely rarely [4]. This is the first reported case of an adenoma of the appendix resected using a traction device during endoscopy.

A 63-year-old man attended our hospital because of a positive fecal occult blood test. Colonoscopy provided a glimpse of the head of a polyp in the appendix, but it was difficult to visualize the whole polyp ([Fig. 1]). We fabricated a rubber strip-based traction device (modified S-O clip) [5] ([Fig. 2]), which we attached to the head of the polyp. A regular clip was used to grasp the distal nylon loop attached to the traction device, which was then inserted and applied to the colon wall opposite the lesion. The traction applied by the clip pulled on the head of the polyp and made the whole polyp visible ([Fig. 3 a], [Video 1]). Traction device-assisted endoscopic submucosal dissection (ESD), employing a HookKnife (Olympus Medical Systems Co., Tokyo, Japan) and electrocautery, was accomplished without complication after injection of a glycerol solution ([Fig. 3 b]). After ESD, the nylon loop was cut with the HookKnife. The resected specimen showed a subpedunculated polyp, 7 × 6 × 5 mm in size ([Fig. 4 a]). Pathological examination revealed a tubular adenoma ([Fig. 4 b]).

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Fig. 1 a Colonoscopy of appendix in a 63-year-old man with a positive fecal occult blood test. b The head of the polyp at the appendix is just seen.
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Fig. 2 Modified S-O clip, consisting of a metallic clip attached by a nylon thread to the edge of a 5-mm rubber strip ring, which is connected to a triple nylon loop at the other end.
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Fig. 3 a A traction device was attached to the head of the polyp, and the traction applied by the clip pulled on the head of the polyp. b Traction device-assisted endoscopic submucosal dissection (ESD) completed without complication.
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Fig. 4 a The subpedunculated polyp with a 7 × 6 × 5 mm head. b Pathological examination revealed a low-grade tubular adenoma.
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Quality:
The distal nylon loop attached to the traction device was grasped with a regular clip. The loop was then inserted and applied to the colon wall opposite the lesion, and the traction applied by the clip on the visible portion of the polyp helped bring whole polyp into the field of vision. Following this, glycerol was injected and traction device-assisted endoscopic submucosal dissection (ESD) of the polyp was carried out successfully.

In this case report we described successful ESD of an appendiceal polyp with a rubber strip-based traction device. We consider this type of traction device to be useful to resect appendiceal polyps.

Endoscopy_UCTN_Code_TTT_1AQ_2AD

 
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