Alternative Endoscopic Techniques for Resection of Colonic Lesions
Dear Colleagues,
Ever find yourself facing a colonic lesion that doesn't quite fit the standard polypectomy mold? This week’s EndoCollab Daily Insight dives into the fascinating world of alternative endoscopic resection techniques, offering practical solutions for those challenging cases.
Clinical Pearl: Don't underestimate the power of the "combo needle-snare" device. This ingenious tool streamlines the injection and snaring process, saving valuable time and device exchanges during your colonoscopies.
Key Takeaways:
Polyp Reshaping: Consider suctioning flat lesions into the endoscope to create a pedunculated shape, making them easier to snare and naturally marking their location.
Combo Needle-Snare: Explore the efficiency of devices combining an injection needle and snare, allowing for immediate snaring post-injection. Early versions had limitations, but newer, smaller diameter devices offer broader applicability.
Underwater EMR: Understand the benefits of performing EMR in a water-filled environment. This technique can improve visualization, disperse electrical energy to potentially reduce deep thermal injury, and magnify the field.
Knife-Assisted Resection (CAR/Hybrid ESD): For lesions that don't lift well, consider a circumferential incision using the tip of your snare or specialized knives before attempting en bloc resection.
Clinical Significance: Mastering these alternative techniques equips you to tackle a wider range of colonic lesions with greater confidence and precision, potentially avoiding more invasive surgical interventions.
Ready to expand your endoscopic armamentarium? Unlock a deeper understanding of these innovative approaches and see them in action.
Head over to EndoCollab to watch the full video now.
P.S. From polyp reshaping to enucleation of lipomas and cap-assisted resection, this video is packed with practical insights you can integrate into your practice immediately. Don't miss out on these expert-driven tips!
Here's a summary of the discussions and learning points from EndoCollab this week:
EndoCollab Weekly Highlights
ERCP and Contrast Media Reactions:
A discussion was initiated regarding the necessity of prepping patients with a history of contrast media allergic-like reactions prior to ERCP.
The consensus leans towards it being irrelevant in the context of ERCP.
A study supporting this viewpoint was shared: "ERCP and contrast media allergic like reaction? Imho it is irrelevant for ERCP. Best study I found" (https://doi.org/10.1155/2018/6296071).
Cecal Polyp Morphology:
A case of a cecal polyp in a 65-year-old woman undergoing screening colonoscopy was presented.
The polyp was located near the appendiceal orifice (not involved) in a patient without a prior appendectomy.
The polyp did not bleed on water irrigation and appeared thick after en bloc removal.
Members discussed the description and differential diagnosis of the polyp based on the provided image.
View the discussion here: "How would you decribe this polyp?"
Novel POEM Incision Technique:
A discussion highlighted a new L-shaped incision technique for Peroral Endoscopic Myotomy (POEM).
Reference material shared: "A new incision for POEM"
Advantages of L-Shaped POEM Incision:
The potential benefits of the L-shaped incision in facilitating easier and quicker submucosal entry during POEM procedures were explored.
Further insights can be found here: "It will make submucosal entry easy and quick for POEM ?"
Management of Refractory Esophageal Strictures:
A challenging case involving a patient with a long refractory esophageal stricture following a corrosive injury was presented.
Previous treatments included triamcinolone, metal stent placement, and Purastat.
Members discussed potential next steps and alternative strategies for managing this complex condition.
See the discussion here: "What would you do if you have a patient with a long refractory esophageal stricture after a corrosive injury? I have already tried triamcinolone, metal stent, Purastat,"
Portal Hypertensive Duodenopathy:
A case of portal hypertensive duodenopathy was shared, observed in an elderly patient with cirrhosis.
Visual documentation of the case can be found here: "Portal hypertensive duodenopathy"
Lemmel Syndrome:
A discussion focused on Lemmel Syndrome, characterized by cholangitis and jaundice.
The underlying mechanism involves a duodenal diverticulum compressing the distal bile duct.
An illustrative MRI image was shared, sourced from Radiopaedia.org: "Lemmel Syndrome: Cholangitis, Jaundice in the Setting of Duodenal Diverticulum (compressing the distal bile duct)"