ASGE DDW Videos from Around the World | 2023-EFTR FOR RECALCITRANT CIRCUMFERENTIAL ADENOMA AT SURGICAL ANASTOMOSIS

EFTR FOR RECALCITRANT CIRCUMFERENTIAL ADENOMA AT SURGICAL ANASTOMOSIS

Video Transcription

Video Summary

In this video, the speaker discusses a case of a recalcitrant adenoma with the use of EFTR (endoscopic full thickness resection) to achieve a definitive R0 resection. The patient is a 70-year-old with multiple comorbidities who had previous treatment for rectal cancer. The adenoma is located at the LAAR (low anterior resection) staple line and the speaker proposes a tunneled circoferential EFTR for resection. The video shows the step-by-step procedure of the EFTR, starting with posterior tunneling and then proceeding anteriorly, with the goal of achieving a complete unblocked cylindrical resection. The speaker emphasizes the importance of traction and the underwater technique for better visualization during the procedure. The video concludes with the successful removal of the adenoma and the importance of EFTR in cases of adenoma recurrence after surgical anastomosis. The speaker acknowledges the challenges of ensuring a negative margin in low rectal tumors and highlights the advantages of EFTR in the subperitoneal pelvic space with scar tissue providing a seal against air escape or peritoneal soiling. The procedure requires advanced ESD skills.

Asset Subtitle

Honorable Mention

Keywords

recalcitrant adenoma

EFTR

R0 resection

LAAR

tunneled circumferential EFTR