Aims:
En-bloc resection of lateral-spreading polyps and flat lesions larger than 2 cm in
size can be challenging. EMR offers the opportunity for resection in piece-meal technique,
but completeness (R0) of the resection remains unclear. In contrast, ESD is complex,
time consuming and associated with a significant rate of perforation.
Methods:
A modified grasp and snare technique was developed using a new external additional
working channel (AWC). The device can be fixed at the tip of a standard gastroscope
or pediatric colonoscope. In the video two different approaches are demonstrated:
In one case en-bloc polypectomy of a 4 cm large flat polyp in the colon near the right
flexure was performed in a modified grasp and snare technique, with an anchoring device
inserted through the working channel and a snare inserted via the AWC. In the other
case an ESD of an early gastric cancer in the antrum at the posterior wall is shown.
Here a grasping snare was introduced via the AWC to enable counter-traction by pushing
away the partly incised lesion during submucosal dissection.
Results:
In both cases the endoscopic procedure was performed successfully with histologically
verified en bloc resection in both cases.
Conclusions:
Based on our preliminary experience the AWC helps to reduce current limitations of
EMR and ESD. Furthermore in contrast to a dual channel endoscope, attachment of the
AWC to a standard endoscope enables variable positions of both working channels by
turning the cap clockwise or counterclockwise before fixation to the scope.
