Post written by Satoki Shichijo, MD, PhD, from the Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.

A 15-mm diameter laterally spreading tumor surrounded by multiple diverticula was pointed out at the ascending colon. The lesion was considered to be an indication for endoscopic resection. However, conventional endoscopic mucosal resection (EMR) of the tumor surrounded by diverticula using submucosal saline injection would have been difficult. Furthermore, endoscopic submucosal dissection (ESD) for tumors adjacent to diverticula carries a high risk of perforation, and demands highly advanced skills, although we have reported successful cases using ESD for colonic polyps involving a diverticulum. We performed Underwater EMR for this tumor, resulting in en bloc resection just in 2 minutes without any adverse event.

Underwater EMR worked very well in this case. By showing the video, readers can understand the method and its efficacy. Underwater EMR is an effective option of endoscopic treatment. Colonic polyps involving or adjacent to diverticula can be removed endoscopically.

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