World Cup 2021-PERISTALTIC CONTRACTIONS HELP SNARING DURING UNDERWATER EMR OF COLONIC NON-GRANULAR PSEUDODEPRESSED LST

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 technique of underwater EMR, introduced by B. Moeller in 2012, is discussed. It avoids the need for submucosal injection by filling the lumen with water, allowing mucosal lesions to float. EUS (endoscopic ultrasound) reveals that the muscular ispropria retains its circular shape, regardless of peristaltic contractions. Depressed lesions are more challenging to remove but during peristaltic contractions, the enfolding of the flat, depressed mucosal lesion makes snaring easier. A case study is presented involving an 85-year-old male with a colonic lesion referred for ESD (endoscopic submucosal dissection). Underwater EMR was successfully performed and the lesion was resected without causing deep moral injury to the muscle wall.

Asset Subtitle

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

Keywords

underwater EMR

B. Moeller

EUS

depressed lesions

ESD