In colorectal endoscopic submucosal dissection (ESD), it is essential to intubate
with the endoscope in a straight position and maintain stable maneuverability during
the procedure. It is however often difficult to obtain these good conditions, especially
in patients with colon elongation, poor fixation, or severe obesity. Recently, a motorized
spiral enteroscope (MSE) was launched [1 ]
[2 ]
[3 ] ([Fig. 1 ]). MSE enables deep intubation and appropriate fixation by rotation of the fins around
the scope to squeeze the intestinal tract. Here, we report a very challenging cecal
ESD in which the MSE was extremely useful ([Video 1 ]).
Fig. 1 Photographs showing the motorized spiral enteroscope with an energy device for colorectal
endoscopic submucosal dissection delivered through the working channel: a full view; b close up of the tip (it can be equipped with a hood, can deliver energy devices,
and has waterjet function capability).
Video 1 Successful endoscopic submucosal dissection is performed using a motorized spiral
enteroscope for a cecal laterally spreading tumor in a patient where intubation was
difficult.
A severely obese 71-year-old man (body mass index 38 kg/m2 ) was found to have a 50-mm laterally spreading tumor in the cecum. Because cecal
intubation was very difficult and ESD was considered very challenging, he was referred
to our hospital. At first, we attempted ESD with a single-balloon endoscope, but we
were unable to reach the lesion sufficiently after trying for more than 90 minutes.
Therefore, we decided to perform ESD with an MSE.
We achieved successful cecal intubation in 13 minutes, without any difficulty. Thereafter,
we performed ESD using the water pressure method [4 ]
[5 ] ([Fig. 2 ]). Although it was difficult to approach the distal side of the lesion, we were able
to overcome this difficulty by suctioning the air and appropriately using forward
rotation. The stable maneuverability of the scope was maintained and the patient did
not complain of discomfort during the procedure. Consistent with this, intraoperative
abdominal radiography showed that there was no migration of gas into the downstream
colon, and the straight scope position was maintained ([Fig. 3 ]). En bloc resection was achieved in 62 minutes, without any adverse events ([Fig. 4 ]).
Fig. 2 White-light image during endoscopic submucosal dissection using the water pressure
method, which was possible because of the stability and maneuverability of the scope.
Fig. 3 Abdominal radiograph during endoscopic submucosal dissection showing no migration
of gas into the downstream colon, and a straight position of the scope.
Fig. 4 White-light photograph of the specimen stained with indigo carmine after successful
R0 resection.
MSE can overcome difficulties in challenging ESD procedures such as this by improving
maneuverability, as well as aiding deep intubation into the small intestine, for which
it was originally developed.
Endoscopy_UCTN_Code_TTT_1AO_2AG
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