Abstract for video honorable mentionsVH12 ESD of a Large Colonic Submucosal Lipoma Causing Recurrent Intussusception
Section snippets
Background
A 54 year old diabetic and hypertensive gentleman, well controlled on medications. He complained of 4 attacks of recurrent abdominal colic with distension in preceding 2 months. The attacks were self-limiting and resolved spontaneously on every occasion. Abdominal contrast enhanced CT scan revealed a large globular swelling at the hepatic flexure suspicious of a lipoma causing intussusception. Colonoscopy was performed which confirmed this finding of a submucosal globular lesion with normal
Endoscopic Methods
Single channel gastroscope with distal cap (standard band ligation cap after firing the bands) was used. Submucosal cushion was created using a modified gelatin solution stained with methylene blue injected through a sclerotherapy needle. Incision was marked using a 1.5mm flat blade ESD knife and soft coagulation. Incision and dissection was performed using the Flushknife underneath the tumor. Combination of blunt and sharp dissection was used to completely separate the tumor from the
Clinical Implications
Small and large bowel submucosal tumors are known to cause intussusception. Surgical resection or enucleation has been the traditional approach for treatment of these tumors. ESD has been traditionally described for left sided colonic lesions and right colonic ESD has been reported infrequently. ESD is feasible in the right colon and can be performed for such submucosal tumors. The technique is similar to ESD for mucosal lesions. Radial EUS of the right colon can be performed to confirm the