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DOI: 10.1055/a-1769-4897
Endoscopic band ligation for the removal of colonic polyp invading the diverticulum
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Endoscopic mucosal resection (EMR) is one of the primary treatment approaches for colonic polyps [1] [2]. However, polyps invading the colonic diverticulum are difficult to identify on whole endoscopic images, making EMR or endoscopic submucosal dissection (ESD) difficult. Moreover, perforation may occur during EMR or ESD for this type of polyp. Endoscopic full-thickness resection can be an alternative approach, albeit costly. Endoscopic band ligation (EBL) is a simple and effective modality to prevent colonic diverticular hemorrhage [3] [4] [5]. Here, we present the utility of EBL for the removal of colonic polyps invading the diverticulum.
A 5-mm IIa lesion invading the diverticulum was identified in the ascending colon. Initially, as much of the visible portion as possible was removed with cold snare polypectomy (CSP) and cold forceps polypectomy (CFP). Thereafter, a pathological diagnosis of tubulovillous adenoma was established. Approximately 6 months after CSP and CFP, the polyp had not disappeared and almost retained its original shape ([Fig. 1 a, b]). After placement of a marking clip ([Fig. 1 c]), EBL was performed with lower endoscopy (PCF-H290Z; Olympus Medical Systems, Tokyo, Japan) and an EBL device (MD-48912B; Sumitomo Bakelite Co., Ltd., Tokyo, Japan) ([Fig. 1 d, ] [Video 1]). EBL allowed the whole polyp to be clearly visualized. The polyp was a 15-mm IIa lesion of Japan NBI Expert Team (JNET) type 2A ([Fig. 1 e]). Biopsy was performed on the polyp after EBL to confirm the pathological findings. The results of the biopsy revealed a tubulovillous adenoma. At follow-up 3 months after EBL, the polyp and diverticulum had completely disappeared ([Fig. 1 f]). The biopsy from the scar showed no tumor remnant.
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Video 1 Endoscopic band ligation for the removal of a colonic polyp invading the diverticulum of the ascending colon.
Qualität:
EBL for the removal of colonic polyp invading the diverticulum was thought to be effective and minimally invasive. As an entire specimen cannot be obtained with EBL, preoperative biopsy and/or evaluation with magnified endoscopy should be performed.
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Publikationsverlauf
Artikel online veröffentlicht:
28. Februar 2022
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References
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