ASGE Endoscopy Live: Colonoscopy (On-demand) | November 2024-Endoscopy Live Case 4

Video Transcription

Video Summary

A 68-year-old male was referred for the resection of a 70-millimeter rectal lesion and a 30-millimeter lesion in the cecum. The rectal lesion, removed by EMR (Endoscopic Mucosal Resection), showed tubulovilous adenoma with high-grade dysplasia. Although the cecal lesion and other small polyps were identified, they were not biopsied or removed initially. The case focused on assessing synchronous disease and ensuring no recurrence at the rectal scar while planning the removal of cecal lesion using EMR and demonstrating mantle-slip closure.<br /><br />The discussion covered the difficulty in detecting flat lesions and considered factors like suboptimal preparation and the expertise of the endoscopist. The video emphasized the importance of clearing the colon entirely in follow-ups and the potential benefits of advanced endoscopy skills in identifying flat lesions, which are often missed.<br /><br />Techniques such as hot avulsion and snare tip soft coagulation were utilized to resect the lesions with meticulous inspection for completeness. Post-resection, the closure of lesions using clips was demonstrated, especially considering the high bleeding risk in the cecum. The discussion underscored cost implications and the need for potential innovations in closure techniques. Overall, the session highlighted the nuanced approach required in handling complex lesions endoscopically.

Keywords

rectal lesion

cecal lesion

endoscopic mucosal resection

tubulovilous adenoma

advanced endoscopy

lesion resection techniques

colonoscopy follow-up