Post written by Akira Yoshida, MD, PhD, from the Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan.

A 50-mm diameter laterally spreading tumor (Paris 0-IIa) that involved the diverticulum on the oral side of the tumor was pointed out at the ascending colon. Colon tumor involving the diverticulum is usually treated by surgical treatment because of the absence of muscle layers. However, we successfully resected a laterally spreading tumor involving the colon diverticulum by endoscopic submucosal dissection without perforation using a knife with water supply function and gravity adjustment. The point of endoscopic treatment involving the diverticulum is keeping the submucosal space of the diverticulum. Colon diverticulum exists depressed from the mucosal level; however, we can pull it out from the mucosal level by using good gravity adjustment. After pulling out a colon diverticulum, it is important to maintain the submucosal space of the diverticulum. One of the effective methods is repeated local injection to the submucosal space using a knife with water supply function, especially with a large water supply lumen. This video shows the procedure and method.

Using a knife with water supply function and gravity adjustment was very useful in this case. I felt it was important that we could show successful resection of a laterally spreading tumor involving the colon diverticulum by endoscopic submucosal dissection without traction device methods. Readers can understand the method and its efficacy from this video. They can learn that a colon tumor involving the diverticulum can be removed by endoscopic treatment using the particular strategy of endoscopic submucosal dissection, as well as surgical treatment.

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