Description:

A 35yrs old patient was considered for the rectum showed a small 1 cms lesion, on magnification endoscopy and on NBI it certainly appeared mitotic and therefore this workup.

• EUS revealed a lesion in the rectum which has breached the submucosal layer
• Muscularis Propria was intact
• The lesion was resected using snare, loop and padlock clip - CBD and gall bladder appeared normal
• Full thickness resection was carried out and the serosal defect was completely closed with this padlock clip
• Complete haemostasis was ensured
• Resected lesion was retrieved and sent for HPE and it turned out to be a Neuro-Lipomatous Lesion.

​Take Home Message:

We are certified to use a dedicated full thickness resection device from a company called OVESCO in Germany. And this case, when a lesion has extended into the submucosal layer then EMR ( Endoscopic Mucosal Resection) or ESD ( Endoscopic Submucosal Dissection) is not feasible hence in this case we ought to do a full thickness resection.We used a very unconventional new technique which proved safe and effective.

I am very confident that this device will make full thickness resection of colo-rectal tumors very safe and thereby may obviate the need for surgery in select cases. We feel that Endoscopic Full Thickness Resection (EFTR) is the next frontier of Endoscopic Surgery which we need to embrace and support.

Image:

1. Caecum

2. Rectum showed a small 1 cms lesion

 

3. Magnification endoscopy and on NBI it certainly appeared mitotic

4. EUS revealed a lesion in the rectum which has breached the submucosal layer

 

5. Muscularis Propria was intact

6. Lesion was anchored and loop was placed.

 

7. Lesion was resected using snare

8. Full thickness resection was carried out

 

9. Padlock clip

10. Serosal defect was completely closed with padlock clip

 

11. Padlock image on X-Ray.

12. Resected Lesion