Post written by Felipe Ramos-Zabala, MD, PhD, from the Department of Gastroenterology, HM Montepríncipe University Hospital, Boadilla del Monte, and the Department of Clinical Sciences, School of Medicine, University of CEU San Pablo, Madrid, Spain.
In this video case report, we describe an endoscopic submucosal dissection (ESD) of a giant rectal polyp with granular nodular mixed LST morphology. This type of lesion carries an associated risk of submucosal invasion, so it is advisable to resect them en bloc in order to perform an adequate histologic study. Using a combined method, we performed the dissection of a specimen size 120 × 80 mm, without adverse events. Although the resection area reached up to 80% of the circumference, in the 24-month follow-up period, the patient did not develop clinical symptoms of post-ESD stenosis.
Our video demonstrates relevant aspects that include: the pocket-creation method in saline solution that improves the dissection plane and water-jet hydrodissection technique for the performance of ESD with a single device.
The use of saline solution provides a clear endoscopic view facilitating vessel identification. The lesion floating effect of the submucosa in immersion generates “traction” that helps lifting the mucosal flap during ESD with the pocket-creation method.
We performed the perimeter cut using T-type hybrid knife in an open position but performed the dissection using this ESD device in a closed position. We have defined this use as hybrid knife “probe mode.” With the use of this monopolar knife, it was possible to perform precoagulation, coagulation, and submucosal dissection in saline solution.
We believe that hybrid knife probe mode can be successfully used to perform ESD and can be especially useful at early stages of the learning process in ESD techniques.
We also hope that this new combined method may be assessed prospectively to examine its efficacy and safety on the treatment of colorectal lesions.
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