S2363 Underwater Full-Thickness Resection of a Colonic Polyp: A Novel Technique

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INTRODUCTION: Underwater resection is an emerging technique in which the gastrointestinal lumen is distended with water instead of air, allowing the mucosal layer to float, facilitating lesion demarcation and resection. Underwater endoscopic mucosal resection (EMR) for colon polyps has been well-studied. Full-thickness resection device (FTRD, Ovesco Endoscopy AG, Tuebingen, Germany) is a dedicated system for single step full-thickness resection of colon lesions that are not amenable for resection by conventional methods. In this study, we combined both techniques to resect a recurrent adenomatous colonic polyp. CASE DESCRIPTION/METHODS: A 52-year-old female patient with no significant past medical history underwent screening colonoscopy which revealed a 2 cm polyp (Kudo IV) in the descending colon. The polyp was completely resected using underwater EMR. Histology report showed tubulovillous adenoma with low grade dysplasia. A follow-up colonoscopy was performed 3 months later and revealed a 2 cm sessile polyp at the previous resection site consistent with recurrent adenoma. Underwater full-thickness resection using FTRD was planned. A colonoscope was inserted and advanced to the lesion site. The FTRD grasper was used to grasp the lesion and pull it completely into the PRVE Cap. The lesion was determined to be amenable to full-thickness resection. The area surrounding the lesion was marked with the FTRD marking probe. The colon lumen was then distended with warm normal saline. The colonoscope was removed and the FTRD device was attached to the scope. The colonoscope with FTRD was then reinserted into the colon and advanced to the site of the lesion. The over-the-scope (OTS) clip was then deployed successfully and the FTRD snare was used to resect the lesion. The entire device and scope were withdrawn from the colon. A second colonoscope was then advanced into the colon to the site of resection with excellent visualization of the resected area. The resected lesion measured 2 cm × 2.5 cm. No complications were reported during or after the procedure. The patient was discharged on the same day. DISCUSSION: The use of FTRD in a water filled colon lumen can improve feasibility, efficacy, and safety of lesion resection via FTRD. Further research should be performed to determine whether the underwater technique enhances the FTRD procedure by possibly reducing procedure time and improving patient outcomes.