Post written by Michiko Wada, MD, and Toshio Uraoka, MD, PhD, from the Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.

We report a case of a 77-year-old woman who had undergone polypectomy for a polyp on the anastomosis of past laparoscopic sigmoidectomy but was referred to our endoscopy unit with recurrent polyp. Colonoscopy revealed a sessile-type recurrent polyp of 15mm in a diameter on the anastomosis, and we performed endoscopic submucosal dissection (ESD) as a salvage treatment. The procedure was technically difficult due to severe fibrosis in submucosal layer and staples remaining on the incision line, but complete resection was successfully attained using multiple devices.

ESD enables secure R0 resection irrespective of size or location of the lesion. However, severe fibrosis is still a condition in which ESD is technically challenging. In this video, we show the technical skills as well as use of multiple devices such as Dual knife, Hook knife, and ST hood, which enabled us to complete the resection, managing to avoid the need for repetitive surgery. We felt sharing the technique and the choice of devices would be useful for other endoscopists who may face similar cases.

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