Lower GI-PERISTALTIC CONTRACTIONS HELP SNARING DURING UNDERWATER EMR OF COLONIC NON-GRANULAR PSEUDODEPRESSED LST

Video Transcription

Underwater, EMR, was described by B. Moeller in 2012. It avoids the need for submucosal injection.  Mucosal lesions float in a lumen filled with water along with mucosa and submucosa. EUS has shown that the muscular ispropia retains a circular configuration and doesn't follow  the involutions of the mucosa and submucosa even during peristaltic contractions. On the other hand, depressed lesions are more difficult to snare.  During peristaltic contractions, enfolding of the flat, depressed mucosal lesion occurs and snaring of the tissue becomes easier. Case 1.  85-year-old male with a 2 cm 02A plus 2C colonic lesion in the right colon with high grade dysplasia on previous biopsy. It was referred for ESD.  Insufflation was stopped, gas was aspirated and the lumen was filled with sterile water. Borders of the lesion were marked and underwater EMR was attempted.  Fetal contraction was starting and we snared the lesion easily.  Before resection, the lesion was pulled off from the muscle wall to avoid deep moral injury.

Video Summary

In this video, the concept of underwater EMR (Endoscopic Mucosal Resection) is discussed, which was first described by B. Moeller in 2012. This method eliminates the need for submucosal injection by allowing mucosal lesions to float in water. It is observed through EUS (Endoscopic Ultrasound) that the muscular layer of the colon retains its circular shape and does not follow the folding of the mucosa and submucosa during peristaltic contractions. Snaring flat, depressed mucosal lesions can be challenging, but during peristaltic contractions, the lesions fold, making snaring easier. The video also presents a case of an 85-year-old male with a colonic lesion referred for ESD (Endoscopic Submucosal Dissection), where underwater EMR was successfully performed to remove the lesion while preventing deep muscle wall injury. <br /><br />(Note: No credits were mentioned in the provided transcript)

Asset Subtitle

World Cup - Authors: Hugo I. Uchima, Juan Colán, Vicente Moreno De Vega, Kenneth F. Binmoeller

Keywords

underwater EMR

Endoscopic Mucosal Resection

submucosal injection

EUS

peristaltic contractions