Endoscopy 2022; 54(01): E34-E35
DOI: 10.1055/a-1362-9196
E-Videos

Endoscopic submucosal dissection of a laterally spreading tumor involving a colonic diverticulum using the counter-traction technique

Thomas Lambin
1  Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
2  Inserm U1032, Labtau, Lyon, France
,
Jérémie Jacques
3  Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
,
Jérôme Rivory
1  Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Florian Rostain
1  Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
,
Timothée Wallenhorst
4  Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
,
Mathieu Pioche
1  Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
2  Inserm U1032, Labtau, Lyon, France
› Author Affiliations
 

Endoscopic submucosal dissection (ESD) is the technique of choice for the resection of superficial colorectal lesions larger than 20 mm [1], but the procedure can be technically challenging in some situations. If a lesion involves a diverticulum, there is fear of a higher risk of perforation due to the lack of muscle layer. However, ESD has recently been described as safe and effective in this particular case [2]. Use of a clip and rubber band (counter-traction technique [3]) can help to achieve a satisfying resection with higher technical comfort. This technique has been proved to be effective and safe for resection of neoplastic lesions involving the appendiceal orifice [4]. However, few data are available for lesions involving a diverticulum [5].

We report the case of a 40 × 30 mm nongranular laterally spreading tumor (NG-LST) deeply invading a colonic diverticulum (Type 3 LST) ([Fig. 1]), which was resected with ESD using the counter-traction technique ([Video 1]).

Zoom Image
Fig. 1 Nongranular laterally spreading tumor deeply invading a colonic diverticulum.

Video 1 Endoscopic submucosal dissection of a laterally spreading tumor involving a colonic diverticulum using the counter-traction technique.


Quality:

After submucosal injection around the diverticulum, complete circumferential incision and deep trimming were performed. The first clip grasping a rubber band was fixed at one side of the lesion and a second clip grasping the same rubber band was fixed at the opposite colonic wall ([Fig. 2]). This counter-traction technique allowed better exposition of the submucosae area under the diverticulum, thus strongly facilitating an en bloc resection ([Fig. 3]). The ulcer floor of the diverticulum was closed by two clips at the end of the procedure to prevent delayed perforation [2]. The patient was discharged the following day without any adverse events. The histopathology report showed an adenoma with high grade dysplasia and a complete en bloc resection (R0).

Zoom Image
Fig. 2 Counter-traction of the lesion with clips and rubber band.
Zoom Image
Fig. 3 The resected piece.

This case report, along with others [5], describes the feasibility of ESD with counter-traction method for resection of LSTs deeply invading a diverticulum.

Endoscopy_UCTN_Code_TTT_1AQ_2AJ

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.

This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos


#

Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Thomas Lambin, MD
Endoscopy Unit – Digestive Disease department
Pavillon L – Edouard Herriot Hospital
69437 Lyon Cedex
France   

Publication History

Publication Date:
23 February 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Nongranular laterally spreading tumor deeply invading a colonic diverticulum.
Zoom Image
Fig. 2 Counter-traction of the lesion with clips and rubber band.
Zoom Image
Fig. 3 The resected piece.