Endoscopy 2022; 54(08): E425-E426
DOI: 10.1055/a-1581-7411
E-Videos

Endoscopic submucosal dissection of a lateral spreading tumor involving the appendiceal orifice using a multi-traction device.

Thomas Lambin
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, France
2   Inserm U1032, Labtau, Lyon, France
,
Jérémie Albouys
3   Gastroenterology and Endoscopy Unit, CHU Dupuytren, Limoges, France
,
Clara Yzet
4   Department of Gastroenterology, Amiens University Hospital, Amiens, France
,
Soline Brun
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
,
Jérôme Rivory
1   Gastroenterology and Endoscopy Unit, Pavillon L, Edouard Herriot Hospital, Lyon, 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 large superficial colorectal lesions [1], but it can be technically challenging in some situations. For this reason, lesions involving the appendiceal orifice have long been removed surgically. However, recent findings have found that ESD is effective and safe in that situation [2] [3], even for lesions deeply invading the appendiceal orifice (Toyonaga 3 lesions) with the help of traction device [4] [5].

Here we report the case of a 70-year-old woman with a history of appendectomy who underwent a colonoscopy that revealed a granular lateral spreading tumor (LST-G) of 3 cm invading the previous site of the appendectomy (Toyonaga 3a) ([Fig. 1]). An ESD using a multi-intertwined loop device was chosen ([Video 1]). After circumferential mucosal incision around the lesion, the first loop of the device was attached to one edge of the lesion with a hemostatic clip. Then a second loop was attached to the opposite edge of the lesion. Then the entire device was attached to the opposite colonic wall. The submucosal space was well exposed at the two edges of the LST-G, allowing a safe dissection during the whole procedure with an en-bloc resection ([Fig. 2], [Fig. 3]). The patient was discharged the day after without experiencing any adverse event. The pathology report showed a high-grade dysplasia with a focus of intramucosal adenocarcinoma that was completely resected by the ESD. Owing to the curative resection, an endoscopic follow-up was decided.

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Fig. 1 A granular lateral spreading tumor invading the previous site of appendectomy.

Video 1 Endoscopic submucosal dissection of a lateral spreading tumor involving the appendiceal orifice using a multi-traction device.


Quality:
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Fig. 2 The submucosal space was well exposed at the two edges of the granular lateral spreading tumor thanks to the multi-traction device.
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Fig. 3 Lesion after resection.

This case highlights that ESD can be safely performed in the appendiceal orifice even with a history of appendectomy. The use of a multi-traction device helped to obtain very satisfying exposure of the submucosal space. A randomized control study evaluating this device would be necessary to confirm this promising result.

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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

Article published online:
08 September 2021

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Zoom Image
Fig. 1 A granular lateral spreading tumor invading the previous site of appendectomy.
Zoom Image
Fig. 2 The submucosal space was well exposed at the two edges of the granular lateral spreading tumor thanks to the multi-traction device.
Zoom Image
Fig. 3 Lesion after resection.