Mastering Endoscopic Resection: A Step-by-Step Guide to Removing LSTs in the Ascending Colon

Gastroenterology & Endoscopy

Episode Overview

• Discussion on the endoscopic resection of a laterally spreading tumor (LST) in the ascending colon.
• Examination of a flat polypoid lesion larger than 10 mm, classified as an LST.

Key Steps in Resection Planning

1. Determining the Lesion's Location: Found between two folds.
2. Analyzing Morphology: Identified as LST-granular.
3. Surface Analysis: Using high-definition white light and narrow-band imaging, revealing a regular, cerebroid mucosal pit pattern without ulcers or depressions (Kudo IIIL).
4. Maintaining Visibility: Employing a "suction" mark technique to keep track of the polyp.

Resection Techniques

• Comparison of "cold snare" and "hot snare" techniques.
• Preference for endoscopic resection using interventional chromoendoscopy.

Interventional Chromoendoscopy

• Submucosal injection with a blue colorant to differentiate tissue types.
• The concept of using colorings to guide therapeutic interventions.

Resection Process

• Using a snare to estimate lesion size and achieve complete entrapment.
• Achieving an endoscopic R0 resection by applying electrosurgical current.

Links:
https://www.thepracticingendoscopist.com/p/endoscopic-resection-of-lst-in-ascending-colon
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353652/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984535/
[3] https://www.linkedin.com/posts/klaus-monkemuller_endoscopic-resection-of-lsts-precise-localization-activity-7159200748767989760-w1yU
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280838/
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308134/
[6] https://www.sciencedirect.com/science/article/pii/S2468448121002034
[7] https://twitter.com/EndoCollabcom/status/1753775490068832549
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414758/
[9] https://www.wjgnet.com/1948-5190/full/v14/i3/113.htm
[10] https://www.elsevier.es/en-revista-ge-portuguese-journal-gastroenterology-347-articulo-large-colorectal-lesions-evaluation-management-S2341454516000107
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132716/
[12] https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/reducing-post-polypectomy-bleeding-events-in-patients-who-require-antithrombotic-agents/mac-20479873
[13] https://www.giejournal.org/article/S0016-5107(20)34187-0/fulltext
[14] https://dmr.amegroups.org/article/view/8102/html
[15] https://www.researchgate.net/publication/260217120_Interventional_chromoendoscopy_Specific_aspects_for_the_colon
[16] https://journals.lww.com/ajg/fulltext/2017/10001/risk_factors_for_delayed_colonic_post_polypectomy.527.aspx
[17] https://www.sciencedirect.com/science/article/pii/S0016510720341870
[18] https://www.giejournal.org/article/S1096-2883(11)00003-9/fulltext
[19] https://karger.com/ddi/article/37/5/364/95746/Accuracy-and-Pitfalls-in-the-Assessment-of-Early
[20] https://www.dovepress.com/pathological-analysis-and-endoscopic-characteristics-of-colorectal-lat-peer-reviewed-fulltext-article-CMAR
[21] https://journals.lww.com/ajg/fulltext/2020/10001/s3373_endoscopic_mucosal_resection_of_a_lateral.3371.aspx
[22] https://www.linkedin.com/posts/endocollab_endoscopic-resection-of-lst-in-ascending-activity-7159541656394887168-cv5C
[23] https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-10-135
[24] https://www.frontiersin.org/articles/10.3389/fmed.2021.728704/full
[25] https://tcr.amegroups.org/article/view/48812/html

https://www.gastroendopod.com