An Y shaped tunnel to bypass a hemorrhoid band ligation scar during rectal endoscopic submucosal dissection
Dana Bilous, Cătălina Vlăduț, Catalin Dutei, Daniela Elena Mihaila, Adrian Tulin, Elena Tianu, Mihai Ciocirlan
Abstract
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TopicsGastric Cancer Management and Outcomes · Esophageal and GI Pathology · Esophageal Cancer Research and Treatment
Endoscopic submucosal dissection (ESD) has advanced significantly in the past decade, incorporating numerous technical enhancements. For colorectal ESD, the European Society of Gastrointestinal Endoscopy (ESGE) recommends the pocket-creation method when traction devices are not employed 1 . Extending and opening the pocket at the opposite side of the lesion creates a tunnel, enabling resection of very large colorectal lesions through single, double, or multiple tunnels 2 3 4 .
We present a 54-year-old woman referred for endoscopic resection of a large rectal laterally spreading tumor (LST). Notably, the anal side of the lesion exhibited a substantial fibrous scar from prior hemorrhoidal band ligation, extending near and beyond the dentate line ( Fig. 1 ). Two years earlier, she had undergone hemorrhoidal band ligation without a preceding colonoscopy.
A large rectal laterally spreading tumor with a fibrous scar after hemorrhoidal band ligation near the dentate line.
To navigate the fibrotic area and achieve en-bloc resection, we employed a Y-shaped tunnel ESD technique ( Video 1 ). At the oral side, there was one opening (the base or the Y letter), while at the anal side, there were two openings (the oblique arms of the Y letter).
An Y-shaped tunnel seen from the oral side during rectal endoscopic submucosal dissection.Video 1
Minimal delayed bleeding occurred one week after the procedure, for which thermal coagulation was performed. Histopathological examination confirmed an R0 resection of a low-grade traditional adenoma.
While ESD of distal rectal LSTs overlying stapled mechanical hemorrhoidectomy sites has been documented, to our knowledge, this is the first reported case utilizing a Y-shaped tunnel to bypass a hemorrhoid band ligation scar during rectal ESD 5 .
Endoscopy_UCTN_Code_TTT_1AQ_2AD_3AZ
The reference list from the paper itself. Each links out to its DOI / PubMed record.
- 1Libânio D Pimentel-Nunes P Bastiaansen B Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review Endoscopy 20235536138910.1055/a-2031-087436882090 · doi ↗ · pubmed ↗
- 2Aslan F Akpinar Z Yurtlu DA Single tunneling method with endoscopic submucosal dissection for treatment of a rectal giant (18-cm) laterally spreading tumor Endoscopy 20174901 E 114E 11610.1055/s-0043-10021828226390 · doi ↗ · pubmed ↗
- 3Stasinos I Toyonaga T Suzuki N Double-tunneling butterfly method for endoscopic submucosal dissection of extensive rectal neoplasms Video GIE 20205808510.1016/j.vgie.201932051917 PMC 7004922 · doi ↗ · pubmed ↗
- 4Aslan F Akpınar Z Kucuk M Multiple tunneling technique for treatment of rectal circumferential laterally spreading tumor with endoscopic submucosal dissection Video GIE 20162323410.1016/j.vgie.2016.11.00329905280 PMC 5990989 · doi ↗ · pubmed ↗
- 5Ferreira FB, Cardoso M, Lourenço LC, Horta D. CC-14 – Long(o) time no see … – ESD of a distal rectum LST over an hemmoroidopexy scar [abstract]https://www.sped.pt/images/Live/programafinal_livesped 2023.pdf