1659 Double Scope Colorectal ESD Using a Gel-Based TAMIS Access Platform

Abstract

INTRODUCTION: Endoscopic submucosal dissection (ESD) is a promising endoscopic procedure that is increasingly being used for endoscopic resection of large colorectal lesions that may be difficult to remove en-bloc by snare polypectomy. The greatest challenge for ESD remains technical difficulty in achieving optimal traction. In the following report, we discuss the use of Gel-based Transanal Access Platform, typically used for Transanal Minimally Invasive Surgery (TAMIS), being used to facilitate ESD of colorectal lesions by facilitating use of two separate endoscopes simultaneously. CASE DESCRIPTION/METHODS: The procedure was first performed on a patient presenting for resection of a 3 cm × 3 cm rectal lesion. Endoscopic ultrasound was performed and the lesion was classified as T1. A decision was made to perform ESD. A 4 × 4 cm Gel based-TAMIS access device was inserted into the anal canal prior to the start of the procedure. Two access holes were made in the gel cover 2 cm apart with the pre-supplied trocars to allow for the passage of a 1T therapeutic gastroscope and an ultraslim gastroscope. After submucosal injection and circumferential incision, the pediatric forceps were passed through the working channel of the ultraslim scope, and the edge of the lesion was grasped and then manipulated to allow for traction of the lesion. ESD was done using a needle type ESD-knife and resection en-bloc was achieved. There were no complications from the procedure and the patient has no anal pain. Histologic examination demonstrated R0 resection Two additional procedures were carried out on two patients with rectal lesions >2 cm and en-bloc resection was achieved in both cases. Histologic examination in each showed tubulovillous adenoma with high grade dysplasia with clear margins. DISCUSSION: By using a commercially available Transanal Access Platform for the first time in an endoscopic procedure, the endoscopist noted more ease performing ESD. This device allowed the insertion of an additional scope which provided more traction and assisted in resecting each lesion without any reported friction between the two scopes. The set-up of this device is simple and this device appears suitable not only for laparoscopic surgical procedures but also for endoscopic interventions. Further studies are underway to determine the technical success, easy of use, and safety of this dual scope with TAMIS platform technique for colorectal ESD.