Subscribe to RSS
DOI: 10.1055/s-0042-109058
Partially insulated cutting instruments for hybrid endoscopic submucosal dissection – the Flat Adenoma Resection Instruments (FARIn)
The endoscopic resection of colorectal polyps that are limited to the mucosa is a well established procedure. Nevertheless, modern imaging technology and screening programs have increased the detection of benign but large (> 20 mm) polyps. In flat laterally spreading tumors (LST), especially the nongranular (NG) type, the rate of submucosal invasion is found to be as high as 39 % (34 % – 44 %) [1]. For this reason a resection in one piece is mandatory [2].
We report on the resection of a 25-mm flat rectal LST-NG in a 60-year-old patient who was admitted to the Klinikum Augsburg after screening colonoscopy ([Fig. 1]). Examination with a high definition colonoscope (CF-HQ 190I; Olympus Medical Systems, Tokyo, Japan) demonstrated a Sano Type II, pit pattern IIIs lesion.
![](https://www.thieme-connect.de/media/endoscopy/2016S01/thumbnails/10-1055-s-0042-109058-i14248cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
We decided to use two newly developed devices, the Flat Adenoma Resection Instruments (Endox-Feinmechanik GmbH, Bad Urach, Germany). Submucosal injection was performed using a mixture of saline, epinephrine (1 : 100 000), glycerol (10 %), and a small amount of indigo carmine solution. Circumferential incision was performed using the FARIn Type I, a rhomboid-shaped device with a small 1-mm cutting tooth at the distal tip. A high frequency generator (VIO 300 D; Erbe, Tübingen, Germany) was configured to AUTO CUT 300 W and FORCED COAG 30 W. After circumferential incision, the specimen could be resected en bloc using the FARIn Type C, a symmetric snare with a cutting wire length of 15 mm ([Fig. 2], [Video 1]).
![](https://www.thieme-connect.de/media/endoscopy/2016S01/thumbnails/10-1055-s-0042-109058-i14248cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Quality:
The histopathological examination showed an adenoma with high grade dysplasia, and an adherent submucosal layer to a depth of > 1000 µm under the entire lesion ([Fig. 3]).
![](https://www.thieme-connect.de/media/endoscopy/2016S01/thumbnails/10-1055-s-0042-109058-i14248cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
In summary, the FARIn instruments allowed the en bloc resection of a large (> 20 mm) LST-NG with adherent submucosal layer (> 1000 µm), which meets the specimen requirements for pathological complete resection (R0).
Endoscopy_UCTN_Code_TTT_1AQ_2AD
#
Competing interests: Dr. Farin is the inventor of the FARIn devices.
-
References
- 1 Yamada M, Saito Y, Sakamoto T et al. Endoscopic predictors of deep submucosal invasion in colorectal laterally spreading tumors. Endoscopy 2016; 48: 456-464
- 2 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2015; 47: 829-854
Corresponding author
-
References
- 1 Yamada M, Saito Y, Sakamoto T et al. Endoscopic predictors of deep submucosal invasion in colorectal laterally spreading tumors. Endoscopy 2016; 48: 456-464
- 2 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2015; 47: 829-854
![](https://www.thieme-connect.de/media/endoscopy/2016S01/thumbnails/10-1055-s-0042-109058-i14248cl1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2016S01/thumbnails/10-1055-s-0042-109058-i14248cl2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/2016S01/thumbnails/10-1055-s-0042-109058-i14248cl3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)