HYBRID APC: A NEW MODALITY FOR TREATMENT OF A DIFFUSELY SPREADING DYSPLASTIC FOREGUT ANASTOMOTIC LESION

Aim:

Endoscopic management of diffusely spreading adenomatous/dysplastic lesion at the site of a gastro-jejunostomy (GJ) anastomosis can be challenging. Endoscopic mucosal resection (EMR) and Endoscopic Submucosal Dissection are technically difficult at such locations and risk incomplete resection. We present a case of endoscopic management of such a lesion in an elderly patient using the novel Hybrid APC technology.

Methods:

A 91 year old male with h/o of roux-en-y GJ (for gastric bypass) was referred for further management of a diffusely spreading dysplastic lesion at the GJ anastomosis. Hybrid APC was used with 30 bar (435 PSI) for injection with the probe at the base of the lesion. After optimal lift of the mucosal area at the lesion site, APC was performed at 60 W pulsed 2 for ablation The treated area was then removed using the mucosal scraping technique with a soft cap attached to the distal end of the gastroscope. Repeat injection – APC treatment was performed to the newly exposed tissue base. Patient was admitted overnight for observation and discharged the next day.

Results:

Repeat endoscopy and biopsy at three and six month post-treatment surveillance intervals revealed normal non-dysplastic mucosa..

Conclusion:

Hybrid APC is a novel therapeutic tool for management of diffusely spreading dysplastic lesions in difficult locations.