First case of clip assisted caecal muscle dissection during ESD

Abstract Text A 57-y-o lady was referred for a Paris 0-Is lesion in the caecum with pattern JNET 2A-B. A SITE-ESD was performed. During the pocket creation, an area of severe fibrosis with muscle retracting sign and increased vascularisation was noted, raising the suspicious of deep submucosal invasion [1] [2]. It was difficult to distinguish the muscle layer from the fibrosis. To avoid intraprocedural perforation, a clip was placed at the base of the fibrosis. This allowed to continue the submucosal dissection and complete the ESD, removing the lesion en-bloc. The patient was safely discharged home on the same day with antibiotic prophylaxis, no complications occurred. Histology revealed a tubular adenoma with low grade dysplasia and a focal area of muscularis propria. To the best of our knowledge, this is the first case to report a partial muscle dissection in the caecum without subsequent perforation.

Video http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/472eb9ae-e558-44bc-8aad-c67a41128f88/Uploads/16849_Caecum_muscle_dissection.mp4

Publication History

Article published online:
27 March 2025

• References

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• 2 Toyonaga T, Tanaka S, Man-i M, East J, Ono W, Nishino E. et al. Clinical significance of the muscle-retracting sign during colorectal endoscopic submucosal dissection. 2015: 246-51