Endoscopy 2022; 54(01): E30-E31
DOI: 10.1055/a-1368-3796
E-Videos

Underwater endoscopic mucosal resection for a sporadic adenoma located at severe longitudinal ulcer scars in ulcerative colitis

Kaoru Takabayashi
1  Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
,
2  Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
3  Division of Gastroenterology and Hepatology Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
,
Motoki Sasaki
2  Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
,
Yasushi Iwao
3  Division of Gastroenterology and Hepatology Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
,
Haruhiko Ogata
1  Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
,
Takanori Kanai
3  Division of Gastroenterology and Hepatology Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
,
Naohisa Yahagi
2  Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
› Author Affiliations

A 52-year-old woman diagnosed with ulcerative colitis (UC) and a history of repeated flare-ups and remissions was referred to our hospital. Colonoscopy revealed a 15-mm, flat elevated lesion in the transverse colon. Magnifying colonoscopy with narrow-band imaging (NBI) showed Japan NBI Expert Team classification type 2A and no flat dysplasia lesion in the periphery. Pathological findings of the biopsy specimen revealed a partial expression of p53. Based on these findings, we suspected sporadic adenoma ([Fig. 1]) rather than ulcerative colitis-associated neoplasia. There were obvious longitudinal ulcer scars as a result of UC inflammation and an endoscopic tattooing scar adjacent to the lesion ([Fig. 2]).

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Fig. 1 Magnifying colonoscopy with narrow band imaging (NBI) showed Japan NBI Expert Team classification type 2A with no flat dysplasia lesion in the periphery.
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Fig. 2 Colonoscopy revealed a 15-mm, flat elevated lesion in the middle-transverse colon. There were obvious longitudinal ulcer scars from ulcerative colitis inflammation and an endoscopic tattooing scar adjacent to the lesion.

We decided to carry out underwater endoscopic mucosal resection (UEMR) for this lesion. After full immersion of the target lesion in natural saline, we captured it under NBI observation using a 20-mm snare (Snare Master; Olympus, Tokyo, Japan) ([Fig. 3]) and removed it. The procedure was completed without any visible neoplastic tissue on the margin of the mucosal defect ([Fig. 4]). En bloc resection without complications was achieved ([Fig. 5], [Video 1]). Histopathological examination revealed a low-grade tubular adenoma without tumor involvement on the horizontal and vertical margins.

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Fig. 3 The lesion was fully immersed in natural saline, captured with a 20-mm snare, and removed under narrow-band imaging observation.
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Fig. 4 Underwater endoscopic mucosal resection was completed without any visible neoplastic tissue on the margin of the mucosal defect.
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Fig. 5 Resected specimen after indigo carmine spraying with negative resection margins.

Video 1 Underwater endoscopic mucosal resection for a sporadic adenoma located at severe longitudinal ulcer scars in ulcerative colitis.


Quality:

Conventional endoscopic mucosal resection (EMR) of polyps on severe scars due to UC is technically challenging [1] because submucosal fibrosis from background inflammation makes it difficult to lift the lesion during submucosal injection and to snare the entire tumor. UEMR has been reported to be an effective technique in cases of severe submucosal fibrosis [2] [3] [4] [5], but it has not been performed in patients with UC after healing from inflammation. This report presents the first case of successful UEMR of a lesion associated with fibrosis secondary to UC remission and tattooing. UEMR may also be effective in resecting polyps on the fibrous mucosa within the area affected by UC.

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Publication History

Publication Date:
22 February 2021 (online)

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