Background Endoscopic submucosal dissection (ESD) of residual or locally recurrent (RLR) colonic lesions after previous endoscopic mucosal resection (EMR) is an attractive but challenging technique. The present study aimed to evaluate the effectiveness and safety of ESD with double clip and rubber band traction (DCT-ESD) of RLR colonic lesions. Methods We retrospectively analyzed all consecutive DCT-ESD procedures for RLR colonic lesions (rectum excluded) performed in two French centers. The frequency of en bloc and R0 resections, procedure speed, additional surgery, and complications were evaluated. R0 resection was also used to investigate the learning curve. Results Among the 53 resections, 49 (92.5 %) were performed en bloc and 42 (79.2 %) achieved R0. The median procedure speed was 21 mm2/min. There were four (7.5 %) intraoperative perforations and one delayed bleeding; these were successfully treated endoscopically. There was no salvage surgery for complications. The R0 rate increased from 16/26 (61.5 %) for the first 26 procedures to 26/27 (96.3 %, P = 0.002) for the last 27 procedures. Conclusions DCT-ESD appears to be a safe and effective treatment for RLR colonic lesions after EMR.

Background and study aims Endoscopic submucosal dissection (ESD) of superficial colorectal lesions in close proximity to the appendiceal orifice (L-PAO) was shown to be feasible except in case of deep invasion into the appendix (type 3 of Toyonaga’s classification). This study aimed to determine the outcomes of ESD with double clip and rubber band traction (DCT-ESD) of L-PAO including a majority of type 3. Patients and methods We reviewed retrospectively all consecutive DCT-ESD of L-PAO performed in 3 French centers. Each lesion was described according to Toyonaga’s classification and type 0 lesions were excluded. The primary outcome was en bloc and R0 resection rates for L-PAO. Morbidity and salvage surgery were recorded. Results A total of 32 patients underwent DCT-ESD; 22 lesions (68.8 %) were type 3, including 11 with previous appendectomy (34.4 %). Median lesion size was 35 mm range (10–110 mm) and median duration of resection was 47 min range (10–230 min). We achieved 100 % of En bloc resection exclusively with DCT-ESD and 90.6 % of histological R0 resection rate. Per-procedure, 11 perforations occurred and were all immediately closed with clips. Overall, 3 patients (10.7 %) underwent surgery without stoma (2 complications related and 1 incomplete resection). No death occurred. Conclusion ESD of lesions deeply invading appendiceal orifice is feasible with the help of a traction system. Technical success by endoscopy avoiding surgery was achieved in 90.6 % of cases.

Patients with large pleural effusions may have underlying pancreatitis with a pancreaticopleural fistula. It is important to establish this diagnosis because treatment may require operative interventions.

No abstract

Endoscopic submucosal dissection using countertraction with clips and rubber band allows safe en bloc resection of recurrent duodenal superficial lesions with intense fibrosis Superficial duodenal epithelial neoplasia (▶ Fig. 1) can be endoscopically removed either with cold snare resection, conventional endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). EMR is safe but can lead to a 20 % -30 % recurrence rate because of piecemeal resections. Conversely, duodenal ESD has a high rate of en bloc resection but is technically challenging and has ≤ 50 % risk of complications (bleeding and perforation) [1,2]. We present the case of a 60-year-old patient with multiple sporadic duodenal adenomas. One of the lesions was particularly challenging because it was a recurrence after a previous EMR. Hybrid endoscopic resection was attempted but impossible due to severe submucosal fibrosis. We therefore performed ESD using the clip and rubber band traction technique (▶ Video 1) [3,4]. We closed the duodenal scar using clips and the patient was discharged after 48 hours of follow-up. The histology exam showed en bloc resection of a low-grade dysplastic duodenal adenoma and there were no complications after 3 weeks of follow-up. This is one of the first video cases showing ESD for duodenal recurrent lesions with severe fibrosis. As a full-thickness resection device for resection of upper digestive tract lesions is not yet approved in Europe, ESD using countertraction techniques can be an option for cases with intense fibrosis and high risk of perforation using conventional EMR.