Non-lifting lesions can occur owing to fibrosis caused by multiple biopsies, submucosal
tumor involvement, and lesions resulting from incomplete resections, among others.
These lesions can be successfully resected using the full-thickness resection device
(FTRD) [1]
[2]
[3]
[4]
[5]. Here we report the case of a patient who, after undergoing endoscopic submucosal
dissection, presented with lesion recurrence. In light of this, the decision was taken
to perform resection with the FTRD.
A colonoscope with a conical cup was advanced to the hepatic flexure of the colon,
where a flat, granular-type, laterally spreading tumor of approximately 4 × 6 cm,
covering 40 % of the perimeter and a complete haustral fold longitudinally, was identified
([Fig. 1 a]). The margins of the lesion were clearly identified. Submucosal injection was performed
to achieve complete elevation of the lesion. Perimeter mucotomy and subsequent endoscopic
submucosal dissection (ESD) of the lesion were performed ([Fig. 1 b]). ESD was then continued from the perimeter toward the center, achieving dissection
of almost 90 % of the lesion. Because the distal edge contained a fold, which prevented
adequate submucosal dissection, the decision was taken to complete excision of the
lesion via snare polypectomy, subsequently fulgurating the mucous borders of the ulcer
site ([Video 1]).
Fig. 1 Endoscopic views showing: a a flat lesion with agranular lateral extension of about 4 x 6 cm, occupying 40 %
of the total perimeter and an entire haustral fold; b endoscopic submucosal dissection (ESD) being performed; c scar folds from the previous ESD with residual adenomatous tissue on colonoscopy
6 months later; d complete wall resection of the segment that contained the residual lesion using the
full-thickness resection device (FTRD); e evidence of a flat scar but no residual adenomatous tissue on the final follow-up
colonoscopy.
Video 1 A laterally spreading tumor in the colon is treated by hybrid endoscopic mucosal
resection; recurrent adenomatous tissue is treated with a full-thickness resection
device (FTRD); the final follow-up colonoscopy shows only the scar from the total
wall resection with no adenomatous tissue present.
A colonoscopy repeated at 6 months revealed recurrence of the adenomatous tissue ([Fig. 1 c]). Therefore, on this occasion, resection with the FTRD was decided upon. Traction
was applied to the tumor fold with a foreign body clamp, and this was followed by
aspiration of the tumor into the FTRD ([Fig. 1 d]). The FTRD was then released, subsequently resulting in total wall resection of
the segment containing the lesion. On a further colonoscopy, 6 months after the first
follow-up colonoscopy, only the scar from the previous complete wall resection was
visible ([Fig. 1 e]).
In conclusion, use of the FTRD represents a good alternative for recurrent colonic
lesions after previous endoscopic resection.
Endoscopy_UCTN_Code_TTT_1AQ_2AD
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in gastroenterological endoscopy. All papers include a high
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