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Naohisa YAHAGI

Cancer Center, Keio University
Tokyo, Japan
MD, PhD
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Difficult endoscopic submucosal dissection (ESD) of a lesion in the left colon
This is the case of a 50 year-old man who underwent a colonoscopy. A 3cm sessile polyp was found, and biopsy results confirmed high-grade dysplasia. The patient was scheduled for endoscopic submucosal dissection (ESD) of the colonic lesion. The procedure started with an accurate endoscopic evaluation of the polyp. The operator injected some Indigo Carmine (IC) on the surface to better visualize the pit pattern and to check the gravity. Once the gravity was assessed, the patient was placed in a supine position. Pit pattern characteristics, also analyzed with the narrow banding imaging (NBI) mode, showed a complete irregular aspect of the central part of the lesion, typical of a cancer with submucosal invasion. ESD was initiated with the submucosal injection which showed a non-lifting sign in the central part. After a mucosal incision was made around the lesion, a difficult submucosal dissection was performed due to fibrosis. The presence of multiple mucinous components was evidenced at the level of the submucosal layer. The lesion was completely resected 'en bloc' with a high suspicion of deep invasion of the muscular layer. Indian ink was injected next to the resected area and the patient was scheduled for a surgical resection.
N Yahagi, M Pizzicannella, F Habersetzer
Surgical intervention
29 days ago
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31:46
Difficult endoscopic submucosal dissection (ESD) of a lesion in the left colon
This is the case of a 50 year-old man who underwent a colonoscopy. A 3cm sessile polyp was found, and biopsy results confirmed high-grade dysplasia. The patient was scheduled for endoscopic submucosal dissection (ESD) of the colonic lesion. The procedure started with an accurate endoscopic evaluation of the polyp. The operator injected some Indigo Carmine (IC) on the surface to better visualize the pit pattern and to check the gravity. Once the gravity was assessed, the patient was placed in a supine position. Pit pattern characteristics, also analyzed with the narrow banding imaging (NBI) mode, showed a complete irregular aspect of the central part of the lesion, typical of a cancer with submucosal invasion. ESD was initiated with the submucosal injection which showed a non-lifting sign in the central part. After a mucosal incision was made around the lesion, a difficult submucosal dissection was performed due to fibrosis. The presence of multiple mucinous components was evidenced at the level of the submucosal layer. The lesion was completely resected 'en bloc' with a high suspicion of deep invasion of the muscular layer. Indian ink was injected next to the resected area and the patient was scheduled for a surgical resection.