Post written by Siddharth B. Javia, MD, from Confluence Health, Wenatchee, Washington, USA.

Our video demonstrates a technique for circumferential endoscopic submucosal dissection (ESD) without using any traction accessories. This was performed in a patient who had significant scarring from Crohn’s colitis and portal hypertension with large blood vessels in the submucosa, which made ESD challenging.

However, dissection was carried out successfully using principles of the pocket creation method and the tunneling dissection method. This case also highlights the adverse event of rectal stenosis that is extremely common in circumferential rectal ESD, especially when it involves the anal canal. We demonstrate that this adverse event is easily treatable with serial dilations.

This case seems to present many challenges that one could encounter during ESD: a circumferential lesion, difficult delineation of the polyp margin because of a background of colitis, a scarred submucosal layer from prior colitis, large blood vessels in submucosa from portal hypertension, and postprocedural rectal stenosis. All these issues combined make it a unique learning case.

ESD is an excellent option in patients with an advanced colorectal polyp as long as there are no signs of deep submucosal invasion. Various obstacles can be overcome by using various tricks and techniques available for these types of complex procedures.

I recommend all my fellow endoscopists watch as many endoscopic videos as possible to expand their skillsets and incorporate newer techniques for day-to-day procedures.

Distal rectal polyp on chromoendoscopy.

Read the full article online.

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