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Create a Free AccountAnatomy - Colorectal
A recurrent lesion with severe fibrosis of colorectal endoscopic submucosal dissection using the combination of pocket-creation method and traction device
Colorectal endoscopic submucosal dissection (ESD) using a pocket-creation method (PCM) is a technique that stabilizes the endoscope by creating a submucosal pocket below the tumor.1 Our previous report showed that it was useful for resecting large colorectal tumors and lesions with severe fibrosis.2 It is also useful in treating tumors when maneuverability of the endoscope is poor because of breathing movement and difficult location. However, it is sometimes difficult to create a submucosal pocket in PCM due to severe fibrosis and location.Precutting EMR with full or partial circumferential incision with a snare tip for the en bloc resection of difficult colorectal lesions
EMR is performed worldwide as a standard therapy for colorectal polyps. It is difficult to achieve en bloc resection by EMR for a colorectal tumor ≥20 mm; the en bloc resection rate for tumors ≥20 mm is reported to be only approximately 30%.1 Additionally, inappropriate elevation resulting from fibrosis and problematic locations can make EMR difficult, even for tumors <20 mm.Colorectal endoscopic submucosal dissection for a lesion on the dentate line area resected with a scissor-type knife
Colorectal endoscopic submucosal dissection (ESD) is a useful technique for resecting large colorectal tumors, but it is technically difficult. The difficulties include patients’ breathing, presence of severe fibrosis, and difficult locations.1-3 One difficult location is the dentate line area because of an abundance of hemorrhoidal vessels (Fig. 1). Clutch Cutter (Fujifilm Co, Tokyo, Japan) is a unique scissor-shaped serrated knife (Fig. 2A).4 This knife enables mucosal incision and submucosal dissection.
