Milan S. Bassan, MBBS (Hons) FRACP from the Division of Gastroenterology, Department of Medicine at the Center of Advanced Therapeutic Endoscopy and Endoscopic Oncology in Toronto, Ontario, Canada and the Department of Gastroenterology and Hepatology, Liverpool Hospital in Liverpool, New South Wales, Australia shares this VideoGIE case “A second chance at EMR: the avulsion technique to complete resection within areas of submucosal fibrosis.”
This video demonstrates the use of the avulsion technique to allow complete resection of a large rectal adenoma that had extensive submucosal fibrosis as a consequence of a previous attempt at endoscopic mucosal resection (EMR). Standard hot biopsy forceps with standard EMR Endocut settings are used to avulse the fibrosed areas after EMR of the surrounding lesion that lifted well. Techniques for haemostasis are also demonstrated.
Submucosal fibrosis, usually due to previous attempts at endoscopic resection or even biopsy, have been demonstrated to reduce the successful resection rate and increase recurrence at EMR. The avulsion technique is a simple method using a standard endoscopic accessory to help overcome this challenge.
The avulsion technique should be considered to allow for the complete resection of fibrosed areas to complete EMR. Tissue is obtained for histological analysis and the depth of resection is visualized to allow for complete lesion clearance. It is a key part of the technique that Endocut rather than pure coagulating current is used and that sufficient traction is placed on the area to be avulsed so that it can be removed with two or three short taps on the yellow pedal.
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