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Endoscopic Submucosal Dissection (ESD) for a 4 cm Sigmoid Polyp with High-Grade Dysplasia

10,440 Aufrufe • vor 1 Jahr •via X (Twitter)

8 Kommentare

Profilbild von ali mohmd
ali mohmdvor 1 Jahr

Is this a stalk? Who not using an endoloop followed by hot snaring??

Profilbild von Flaubert Sena de Medeiros
Flaubert Sena de Medeirosvor 1 Jahr

For a polyp with a large cephalic portion and a narrow sigmoid, do not rely on opening the loop and the snare. However, this is just one tactic.

Profilbild von pedro bastos
pedro bastosvor 1 Jahr

cautery settings?

Profilbild von Marcio Paraboli
Marcio Parabolivor 1 Jahr

@AdrianaPhalange Congrats Great Job👏👏👏

Profilbild von Syed Saad Ahmed
Syed Saad Ahmedvor 1 Jahr

Omg

Profilbild von د يوسف بن طواله
د يوسف بن طوالهvor 1 Jahr

Hi . can you please send me a direct message . Thanks

Profilbild von Romulo Freire
Romulo Freirevor 1 Jahr

O que você usou para injeção?

Profilbild von Flaubert Sena de Medeiros
Flaubert Sena de Medeirosvor 1 Jahr

Salina com azul

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*Video and images shown with full, written informed consent from the patient. Our first ESD of 2024, performed last week, using our saline-immersion technique (SITE)-facilitated, tri-tunnel variation of the pocket-creation method (PCM). The lesion was a 12 x 9cm laterally spreading tumour involving the ileocaecal valve, caecum and ascending colon*. Dissection speed: 28.3 mm^2/min. SITE, which we first described in 2016, enhances patient comfort (avoiding the need for deep sedation), obviates the need for any traction (through buoyancy), enhances optical clarity (through elimination of dissection-related smoke, fat micelles, debris and through intrinsic magnification), and enhances visualisation of vessels and bleeding points. The use of saline (not water) is critical for conductivity. High-effect, forced coagulation enables very effective knife-alone management of vessels and any bleeding, and this, coupled with the use of self-assembling protein matrix gel (Purastat), obviates the need for the use of coagulation forceps. All these factors contribute to increased efficiency, effectiveness and patient comfort. Histopathology of the specimen confirmed complete (R0) resection and showed that the lesion consisted of a low grade dysplastic lesion without any evidence of invasive malignancy, confirming cure. ESD is an endoscopic microsurgical technique which affords an en bloc, organ-preserving, minimally invasive cure for such lesions, which unlike piecemeal resection, offers R0 with virtually no risk of recurrence; this latter point eliminates the need for tight surveillance and related patient inconvenience/risk, also reducing cost and environmental impact. Onwards and upwards for the betterment of minimally invasive care for all our patients!

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