Traction-assisted and saline immersion endoscopic submucosal dissection of a peri-appendiceal large non-pedunculated colorectal polyp

Abstract Text ESD is a viable alternative for the treatment of appendiceal lesions as shown in previous studies [1] [2] [3]. While traction has been described in appendiceal ESD [2] [3], the combination of multi-band traction with intermittent saline immersion is novel. This video demonstrates an ESD procedure using this approach to treat a 35mm type 3 lesion [1] (Paris 0-IIa, JNET 2b) in a 77-year-old patient, achieving a R0 resection without complications. Histopathology confirmed pT1 adenocarcinoma with no high-risk features other than depth of invasion. After discussion of options, the patient opted for completion surgery with no residual adenocarcinoma and 0/12 positive lymph nodes. This case illustrates how multipoint traction and saline immersion facilitate complete resection in difficult appendiceal lesions.

Video  http://data.process.y-congress.com/ScientificProcess/Data//106/570/1428/c8453c08-a5a1-4284-977a-1760f73e346f/Uploads/16849_esge_esd_appendix_(1080p).mp4

 

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Conflicts of interest

DJT: Fujifilm and Olympus research support and consulting. ​ The other authors declare that they have no conflicts of interest.

• References

• 1 Jacob H, Toyonaga T, Ohara Y. et al. Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice. Endoscopy 2016; 48: 829-836
• 2 Oung B, Rivory J, Chabrun E. et al. ESD with double clips and rubber band traction of neoplastic lesions developed in the appendiceal orifice is effective and safe. Endosc Int Open 2020; 8: E388-e395
• 3 Figueiredo M, Yzet C, Wallenhorst T. et al. Endoscopic submucosal dissection of appendicular lesions is feasible and safe: a retrospective multicenter study (with video). Gastrointest Endosc 2023; 98: 634-638

Publication History

Article published online:
27 March 2025