So, you'll see here a 68-year-old woman. She had this non-lifting, non-granular area. It's got a KUDO5I or 5N pattern, and that pattern is at about a 40% chance of malignancy. And this shows you how we've removed that. This was actually, it wasn't malignancy, but it was low-grade dysplasia. Now I'm going to go back here, and this is pause. Let's go back just a bit. Sorry, I should have paused you a little bit earlier. That's perfect. We pause there. You can see here, this is after that resection, that full thickness resection of that flat lesion. And now we're going back in follow-up, and that polypoid area is what we see as a reaction to the device, which falls off after three to six months. But then when we look very closely at the scar with near focus, we can see an area of great concern again for malignancy. We'll go ahead and play that. The biopsy of that scar showed high-grade dysplasia, so we're going back now. This is with a cap, and we're looking with, we'll pause in a moment. Pause right there. That's good right there. Okay. At this point now, we're looking with near focus, and we're looking with NBI and with a cap. And if you look just to the right here, I'm not sure if you see my arrow here, but this is an area where we've lost the pit pattern. It's type 5, and again, as I mentioned, it's irregular or not present. Very concerning for malignancy. And we'll, even though the last time, of course, the first time around, pathology did not show it. We'll carry on here. And this area I was very concerned about. It was very flat. It was a scar. This is the margin that you can see here. So we're going to mark the lesion that we want, the scar that we want to resect. And you can see that again. Now we're going back. We'll pause here. This is your full thickness device. So what this is, it's a friction cap that goes on the end of your colonoscope, and it's a large cap which extends out about 23 millimeters beyond the end of your scope. So it's a very rigid extension. The external diameter is fairly large. It's about 21 millimeters, and the internal diameter is about 13 millimeters. So we're counting on roughly pulling up a 2-centimeter diameter area of tissue into the cap. And what will happen is we deploy a clip. We'll play that. And we're going to pull the lesion up into the cap with all the marks hopefully pulled in. That white band, as we release the clip, will descend on the cap. And as it descends, we're waiting to clip the lesion. And once it's descended, we can cut it and remove the lesion. And then we usually go back and have a look. Now, you'll see here that the pathology on what we removed there, in fact, was intramucosal cancer. And that's been delineated here for you. And we'll go close up. You can see the malignant glands within the mucosa. So this shows you the advantage of a full thickness resection. We ensure that we have RO margins and then save the patient from unnecessary surgery. So the full thickness resection device has been extremely useful. We use it both for isolated lesions or small lesions, or we use it in a hybrid fashion where we remove the periphery of the lesion and in the central area, which is non-lifting or has a worse pit pattern, we'll use the full thickness device on that. So that gives you an idea of some of the advanced techniques that we have for worrisome lesions.

colon

malignancy

lesion removal

pathology

advanced techniques