Villous adenoma in a perforated colonic diverticulum

Endoscopic Management of a Tubulovillous Adenoma Within a Diverticulum: Report of a Case and Review of Literature

Adenomas or adenocarcinomas located within a colonic diverticulum are considered a rare phenomenon that has been described in the literature. These lesions are technically difficult to manage endoscopically and usually require surgical intervention for removal. There is also an increased risk of perforation upon endoscopic resection owing to the lack of a muscular layer within the diverticulum. We report a case and include a literature review to evaluate different endoscopic techniques and propose the most effective for management of adenomas within a diverticulum. This technique is potentially comprised of employing a combined approach using a suction banding device, an over-the-scope clip (OTSC; Ovesco Endoscopy AG, Tübingen, Germany) , and hyperthemic snare to successfully remove the polyp, ensure tissue retrieval, and reduce risk of iatrogenic colonic perforation.

Safe and successful resection of difficult GI lesions using a novel single-step full-thickness resection device (FTRD®)

BACKGROUND AND STUDY AIMS

Classic endoscopic resection techniques (EMR and ESD) are limited to mucosal lesions. In the case of deeper growth into the gut wall and anatomic sites prone to perforation, the novel full-thickness resection device (FTRD®) opens a new dimension of possibilities for endoscopic resection.

PATIENTS AND METHODS

Sixty patients underwent endoscopic full-thickness resection (eFTR) at our institution. Safety, learning curve, R0 resection rate, and clinical outcome were studied.

RESULTS

In 97% (58/60) of the interventions, the FTRD®-mounted endoscope reached the previously marked lesion and eFTR was performed (technical success). Full-thickness resection was achieved in 88% of the cases, with an R0 resection on histological examination in 79%. The clinical success rate based on follow-up histology was even higher (88%). Adverse events occurred in 7%. Appendicitis of the residual cecal appendix after eFTR of an adenoma arising in the appendix led to the only post-eFTR surgery (1/58, 2%). Minor bleeding at the eFTR site (2/58, 3%) and an eFTR performed accidently without proper prior deployment of the OTSC® (1/58, 2%) were successfully treated endoscopically. There was no secondary perforation or eFTR-associated mortality.

CONCLUSIONS

After specific training, eFTR is a feasible, safe, and promising all-in-one endoscopic resection technique. Our data show that eFTR allows complete resection of lesions affecting layers of the gut wall beneath the mucosa with a low risk of adverse events. However, our preliminary results need to be confirmed in larger, controlled studies.

A sessile (diminutive) polyp within a sigmoid diverticulum--EMR or observe?

Endoscopic mucosal resection (EMR) is a well-established technique for excision of colo-rectal polyps, which can be technically challenging when the polyp is inside a diverticulum, as colonic perforation may easily occur due to the lack of muscular coats. Here we report, to our knowledge, the first case of sessile (diminutive) polyp inside a diverticulum being successfully removed entirely by EMR.

Perforation of sigmoid diverticulum following endoscopic polypectomy of an adenoma

Colonic polyps or carcinomas located within a colonic diverticulum are very rare phenomena. There are a few reports in the literature describing adenocarcinoma arising within colonic diverticulum. Endoscopic resection of the polyp poses a risk of perforation because of the lack of muscular coats in the diverticulum. Therefore, special care should be taken in the treatment of such patients.