Post written by Hiroyuki Aihara, MD, PhD, FASGE, from the Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.

This case video demonstrates a hybrid endoscopic submucosal dissection (ESD) with a novel ESD knife, followed by mucosal defect closure using an innovative endoscopic helix tacking system. A 60-year-old man with a history of adenomatous colon polyps presented to our institution for surveillance colonoscopy. His colonoscopy revealed a carpet-like, 40-mm, laterally spreading tumor (LST) granular-type lesion in the sigmoid colon. The hybrid ESD was performed without adverse events, followed by a defect closure using the through-the-scope (TTS) type suturing device. The specimen was noted to be 5×5 cm, with final pathology demonstrating a margin-negative tubulovillous adenoma. The patient was discharged home the same day post procedure.

Hybrid ESD is known to be associated with decreased procedure time and fewer adverse events, but lower en bloc resection rates compared with conventional ESD. Therefore, a strategical approach should be considered to minimize the risk of piecemeal resection in hybrid ESD. A step-by-step scheme of the hybrid ESD is described in this article. Also, in hybrid and conventional colonic ESD, the large mucosal defects are associate with the risk of delayed bleeding and perforation. Closure of these mucosal defects might minimize the risk; however, it has been challenging due to the lack of appropriate closure devices. The novel TTS suturing device facilitates a secure closure of these large post-ESD mucosal defects. These new tools and techniques for ESD may allow for more widespread adoption of ESD in the United States.

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